Provider Demographics
NPI:1184934473
Name:NAFFAH CASTILLO, DIANA MARCELA (DDS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARCELA
Last Name:NAFFAH CASTILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:NAFFAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2126 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1450
Mailing Address - Country:US
Mailing Address - Phone:954-625-0110
Mailing Address - Fax:
Practice Address - Street 1:2711 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3637
Practice Address - Country:US
Practice Address - Phone:954-321-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20963122300000X
CA49609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist