Provider Demographics
NPI:1619013810
Name:DOMINIC A. CASTALDO
Entity Type:Organization
Organization Name:DOMINIC A. CASTALDO
Other - Org Name:DOMINIC A. CASTALDO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTALDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-444-5042
Mailing Address - Street 1:120 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3000
Mailing Address - Country:US
Mailing Address - Phone:610-444-5042
Mailing Address - Fax:
Practice Address - Street 1:120 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3000
Practice Address - Country:US
Practice Address - Phone:610-444-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016128L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty