Healthcare Provider Details

I. General information

NPI: 1992174346
Provider Name (Legal Business Name): CARUS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BEE CAVES RD SUITE C
WEST LAKE HILLS TX
78746-6657
US

IV. Provider business mailing address

7517 CAMERON RD SUITE 107
AUSTIN TX
78752-2057
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-5739
  • Fax:
Mailing address:
  • Phone: 512-371-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21442
License Number StateTX

VIII. Authorized Official

Name: DR. MALCOLM RAY SCOTT
Title or Position: PRESIDENT
Credential: DDS
Phone: 512-371-1222