Provider Demographics
NPI:1689852998
Name:CAROLINA CASTANEDA DDS, INC
Entity Type:Organization
Organization Name:CAROLINA CASTANEDA DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-780-0223
Mailing Address - Street 1:4560 CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-780-0223
Mailing Address - Fax:323-780-0494
Practice Address - Street 1:4560 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1117
Practice Address - Country:US
Practice Address - Phone:323-780-0223
Practice Address - Fax:323-780-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB35852261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770625337OtherMEDICAL