Provider Demographics
NPI:1700958956
Name:CASTLE 1ST DENTAL CARE PA
Entity Type:Organization
Organization Name:CASTLE 1ST DENTAL CARE PA
Other - Org Name:BRIGHT NOW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARACELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTENEGRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:1770 N. WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-253-9792
Mailing Address - Fax:321-253-9797
Practice Address - Street 1:1770 N. WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-253-0606
Practice Address - Fax:321-253-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117471223G0001X
FLDN86781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty