Provider Demographics
NPI:1013939164
Name:CASTILLO, YISELLE ZENIT (DDS)
Entity Type:Individual
Prefix:
First Name:YISELLE
Middle Name:ZENIT
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2301
Mailing Address - Country:US
Mailing Address - Phone:516-801-0787
Mailing Address - Fax:
Practice Address - Street 1:160 E 32ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6004
Practice Address - Country:US
Practice Address - Phone:212-683-3328
Practice Address - Fax:212-683-0021
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics