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NPI Code Detail

MEDICARE: CHRISTEN JADE CARUTE D.D.S.

MEDICARE:   CHRISTEN JADE CARUTE  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry058790NY

General Provider Information

NPI Number : 1043691306
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTEN JADE CARUTE D.D.S.
Provider Business Mailing Address
First Line : 255 MASON AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3416
Country : US
Telephone Number : 718-987-6543
Fax Number :
Provider Business Practice Location Address
First Line : 255 MASON AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3416
Country : US
Telephone Number : 718-987-6543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2015
Last Update Date : 12/05/2018

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Directions to “ CHRISTEN JADE CARUTE D.D.S.” Practice Location

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