Provider Demographics
NPI:1922860832
Name:CASTRO DDS PLLC
Entity Type:Organization
Organization Name:CASTRO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CREDENTIALING AND ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOMINO-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-277-3633
Mailing Address - Street 1:PO BOX 70887
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-0887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5930 CENTENNIAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4558
Practice Address - Country:US
Practice Address - Phone:702-854-3287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty