Provider Demographics
NPI:1093395436
Name:CASTRO DENTAL GROUP, PC
Entity Type:Organization
Organization Name:CASTRO DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-898-1234
Mailing Address - Street 1:2411 HARTNELL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2325
Mailing Address - Country:US
Mailing Address - Phone:530-244-3500
Mailing Address - Fax:530-244-2807
Practice Address - Street 1:2411 HARTNELL AVE STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2325
Practice Address - Country:US
Practice Address - Phone:530-244-3500
Practice Address - Fax:530-244-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty