Provider Demographics
NPI:1346391679
Name:CASTANO, RAUL A (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:A
Last Name:CASTANO
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:DR
Other - First Name:GERALD
Other - Middle Name:M
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD,PA
Mailing Address - Street 1:3300 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6350
Mailing Address - Country:US
Mailing Address - Phone:407-295-9096
Mailing Address - Fax:407-295-8118
Practice Address - Street 1:3300 S HIAWASSEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6350
Practice Address - Country:US
Practice Address - Phone:407-295-9096
Practice Address - Fax:407-295-8118
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2015-02-03
Deactivation Date:2011-09-20
Deactivation Code:
Reactivation Date:2015-02-03
Provider Licenses
StateLicense IDTaxonomies
FL00145001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203232694OtherFEDERAL TAX ID NUMBER