Provider Demographics
NPI:1164649950
Name:DR. MARK S CASTOR DDS
Entity Type:Organization
Organization Name:DR. MARK S CASTOR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-441-7777
Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:SUITE 207 A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6888
Mailing Address - Country:US
Mailing Address - Phone:512-441-7777
Mailing Address - Fax:512-441-7632
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE 207 A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6888
Practice Address - Country:US
Practice Address - Phone:512-441-7777
Practice Address - Fax:512-441-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty