Provider Demographics
NPI:1518016781
Name:CASTALDO, VINCENZO JOHN III (DMD)
Entity Type:Individual
Prefix:
First Name:VINCENZO
Middle Name:JOHN
Last Name:CASTALDO
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7601 HOSPITAL DR
Mailing Address - Street 2:104B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5408
Mailing Address - Country:US
Mailing Address - Phone:916-423-4092
Mailing Address - Fax:916-423-3125
Practice Address - Street 1:7601 HOSPITAL DR
Practice Address - Street 2:104B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5408
Practice Address - Country:US
Practice Address - Phone:916-423-4092
Practice Address - Fax:916-423-3125
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery