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General NPI Number Information
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NPI Number | 1740663764
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Entity Type | Organization
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Legal Business Name | CARUS DENTAL PC
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 19121 W LAKE HOUSTON PKWY STE E
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City | HUMBLE
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State | TX
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Zip | 77346-4826
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Country | US
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Telephone | 281-446-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 19121 W LAKE HOUSTON PKWY STE E
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City | HUMBLE
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State | TX
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Zip | 77346-4826
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Country | US
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Telephone | 281-446-2153
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CELIA HAYES
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Credential |
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Telephone | 217-540-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15769
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License Number State | TX
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