Provider Demographics
NPI:1356343164
Name:WAYNE W CASTLE DDS PC
Entity type:Organization
Organization Name:WAYNE W CASTLE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-772-8020
Mailing Address - Street 1:1361 FRANCIS ST
Mailing Address - Street 2:STE 202
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2576
Mailing Address - Country:US
Mailing Address - Phone:303-772-8020
Mailing Address - Fax:303-772-1525
Practice Address - Street 1:1361 FRANCIS ST
Practice Address - Street 2:STE 202
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2576
Practice Address - Country:US
Practice Address - Phone:303-772-8020
Practice Address - Fax:303-772-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COH-D-1-006301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty