Provider Demographics
NPI:1124103767
Name:CASTRO, AXEL (DMD)
Entity type:Individual
Prefix:DR
First Name:AXEL
Middle Name:
Last Name:CASTRO
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 1:422 S. ALAFAYA TRAIL
Mailing Address - Street 2:STE 27
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-380-7046
Mailing Address - Fax:407-380-7174
Practice Address - Street 1:422 S. ALAFAYA TRAIL
Practice Address - Street 2:STE 27
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:407-380-7046
Practice Address - Fax:407-380-7174
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 165361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice