Provider Demographics
NPI:1326191651
Name:CASTELLAN, ALBERT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MICHAEL
Last Name:CASTELLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3726
Mailing Address - Country:US
Mailing Address - Phone:708-450-1170
Mailing Address - Fax:708-450-0008
Practice Address - Street 1:818 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3726
Practice Address - Country:US
Practice Address - Phone:708-450-1170
Practice Address - Fax:708-450-0008
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice