Provider Demographics
NPI:1881312965
Name:CASTO, GRANT (DDS)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:CASTO
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 1:4014 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:STE B
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:321-248-2923
Mailing Address - Fax:
Practice Address - Street 1:910 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1766
Practice Address - Country:US
Practice Address - Phone:772-785-9515
Practice Address - Fax:772-785-5308
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN273291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice