Provider Demographics
NPI:1245406511
Name:CASTRO, ROGER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:CASTRO
Suffix:
Gender:M
Credentials:DDS
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2373 CENTRAL PARK BLVD UNIT 305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2301
Mailing Address - Country:US
Mailing Address - Phone:303-399-5437
Mailing Address - Fax:303-399-5445
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2301
Practice Address - Country:US
Practice Address - Phone:303-399-5437
Practice Address - Fax:303-399-5445
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYP588171223G0001X
CODEN002033981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice