Provider Demographics
NPI:1073631131
Name:CASTILLO & MULKAY DENTAL, P.C.
Entity Type:Organization
Organization Name:CASTILLO & MULKAY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-330-3333
Mailing Address - Street 1:7 CORN MILL CT
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1232
Mailing Address - Country:US
Mailing Address - Phone:201-825-2120
Mailing Address - Fax:
Practice Address - Street 1:3133 CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2423
Practice Address - Country:US
Practice Address - Phone:201-330-3333
Practice Address - Fax:201-617-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NJ1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3408906Medicaid
NJ3408914Medicaid