MEDICARE: CARUS DENTAL PC

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1063164135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARUS DENTAL PC

Provider Business Mailing Address
First Line	:	9001 BRODIE LN STE C1
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5005
Country	:	US
Telephone Number	:	512-282-5900
Fax Number	:	512-282-5900

Provider Business Practice Location Address
First Line	:	9001 BRODIE LN STE C1
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5005
Country	:	US
Telephone Number	:	512-282-5900
Fax Number	:	512-282-5900

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	CELIA HAYES
Credential	:
Telephone Number	:	217-540-2100

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	01/20/2022

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