Provider Demographics
NPI:1013166941
Name:CASTLETON GENERAL & IMPLANT DENTISTRY PC
Entity type:Organization
Organization Name:CASTLETON GENERAL & IMPLANT DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARRS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-849-3597
Mailing Address - Street 1:6535 E 82ND ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4524
Mailing Address - Country:US
Mailing Address - Phone:317-849-3597
Mailing Address - Fax:317-913-0641
Practice Address - Street 1:6535 E 82ND ST
Practice Address - Street 2:SUITE 211
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4524
Practice Address - Country:US
Practice Address - Phone:317-849-3597
Practice Address - Fax:317-913-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011157A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty