MEDICARE: CARUS DENTAL

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	21442	TX

General Provider Information

NPI Number	:	1992174346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARUS DENTAL

Provider Business Mailing Address
First Line	:	7517 CAMERON RD
Second Line	:	SUITE 107
City	:	AUSTIN
State	:	TX
Zip	:	78752-2057
Country	:	US
Telephone Number	:	512-371-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 BEE CAVES RD
Second Line	:	SUITE C
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6657
Country	:	US
Telephone Number	:	512-329-5739
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MALCOLM RAY SCOTT
Credential	:	DDS
Telephone Number	:	512-371-1222

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	09/16/2015

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