Provider Demographics
NPI:1518398809
Name:CASTOR DENTAL GROUP
Entity Type:Organization
Organization Name:CASTOR DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-933-2778
Mailing Address - Street 1:153 BRADY STREET EXT
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-8701
Mailing Address - Country:US
Mailing Address - Phone:336-824-8300
Mailing Address - Fax:
Practice Address - Street 1:153 BRADY STREET EXT
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-8701
Practice Address - Country:US
Practice Address - Phone:336-824-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTOR DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty