Provider Demographics
NPI:1942394192
Name:DECASTRO, EDWARD MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARTIN
Last Name:DECASTRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2125
Mailing Address - Country:US
Mailing Address - Phone:315-363-4850
Mailing Address - Fax:315-363-4678
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2125
Practice Address - Country:US
Practice Address - Phone:315-363-4850
Practice Address - Fax:315-363-4678
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038236-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice