Provider Demographics
NPI:1811137813
Name:CASTANEDA, HERMAN (DD)
Entity type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:425-338-9111
Mailing Address - Fax:425-338-0111
Practice Address - Street 1:16030 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 270
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-338-9111
Practice Address - Fax:425-338-0111
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60034322122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist