Provider Demographics
NPI:1366522013
Name:CARUS DENTAL PC
Entity type:Organization
Organization Name:CARUS DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATORS
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:301 W HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4403
Mailing Address - Country:US
Mailing Address - Phone:512-396-7268
Mailing Address - Fax:512-353-8964
Practice Address - Street 1:301 W HOPKINS
Practice Address - Street 2:
Practice Address - City:SAN MARCUS
Practice Address - State:TX
Practice Address - Zip Code:78666
Practice Address - Country:US
Practice Address - Phone:512-396-7268
Practice Address - Fax:512-353-8964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARUS DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty