Provider Demographics
NPI:1184705832
Name:CASTO, GLEN THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:THOMAS
Last Name:CASTO
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 1:8306 SE SANCTUARY DR
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-3960
Mailing Address - Country:US
Mailing Address - Phone:772-546-8784
Mailing Address - Fax:
Practice Address - Street 1:860 US HIGHWAY 1
Practice Address - Street 2:101
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3879
Practice Address - Country:US
Practice Address - Phone:561-624-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics