Provider Demographics
NPI:1851797823
Name:CASTANO, RODRIGO (LD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:CASTANO
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5110
Mailing Address - Country:US
Mailing Address - Phone:971-388-7725
Mailing Address - Fax:
Practice Address - Street 1:125 LANCASTER DR. NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4104
Practice Address - Country:US
Practice Address - Phone:971-388-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10150616122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist