Provider Demographics
NPI:1902383557
Name:CASTELLANO, ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 WALNUT ST APT 801
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3107
Mailing Address - Country:US
Mailing Address - Phone:570-575-6906
Mailing Address - Fax:
Practice Address - Street 1:801 OLD YORK RD STE 403
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1625
Practice Address - Country:US
Practice Address - Phone:215-277-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0418001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice