Provider Demographics
NPI:1386865475
Name:CASTRO, PEDRO ALBERTO (DMD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALBERTO
Last Name:CASTRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 AVE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1662
Mailing Address - Country:US
Mailing Address - Phone:787-728-6035
Mailing Address - Fax:787-728-3719
Practice Address - Street 1:67 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1662
Practice Address - Country:US
Practice Address - Phone:787-728-6035
Practice Address - Fax:787-728-3719
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice