Healthcare Provider Details

I. General information

NPI: 1013382191
Provider Name (Legal Business Name): CARUS DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21450 KUYKENDAHL RD STE 140
SPRING TX
77379-2663
US

IV. Provider business mailing address

21450 KUYKENDAHL RD STE 140
SPRING TX
77379-2663
US

V. Phone/Fax

Practice location:
  • Phone: 512-237-2448
  • Fax: 512-237-2543
Mailing address:
  • Phone: 512-237-2448
  • Fax: 512-237-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30141
License Number StateTX

VIII. Authorized Official

Name: CELIA HAYES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-2100