Provider Demographics
NPI:1801448527
Name:CASTILE, EVAN COREY (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:COREY
Last Name:CASTILE
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 1:8152 25 MILE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1904
Mailing Address - Country:US
Mailing Address - Phone:586-747-2151
Mailing Address - Fax:
Practice Address - Street 1:8152 25 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-1904
Practice Address - Country:US
Practice Address - Phone:586-992-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016002091223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice