Provider Demographics
NPI:1356715411
Name:CARLOS A CASTRO DDS PC
Entity type:Organization
Organization Name:CARLOS A CASTRO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-381-9333
Mailing Address - Street 1:1942 ATKINSON ROAD
Mailing Address - Street 2:500
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:770-381-9333
Mailing Address - Fax:
Practice Address - Street 1:1942 ATKINSON RD
Practice Address - Street 2:500
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5003
Practice Address - Country:US
Practice Address - Phone:770-381-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty