Provider Demographics
NPI:1851586119
Name:CASTILLO, MINERVA J (DMD)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:J
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3526
Mailing Address - Country:US
Mailing Address - Phone:305-888-1458
Mailing Address - Fax:786-235-0257
Practice Address - Street 1:1370 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3526
Practice Address - Country:US
Practice Address - Phone:305-888-1458
Practice Address - Fax:786-235-0257
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-17858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist