MEDICARE: CASTILLO DENTAL & ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN03079	RI

General Provider Information

NPI Number	:	1184928798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTILLO DENTAL & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2148 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-1722
Country	:	US
Telephone Number	:	401-232-7777
Fax Number	:	401-232-1209

Provider Business Practice Location Address
First Line	:	2148 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-1722
Country	:	US
Telephone Number	:	401-232-7777
Fax Number	:	401-232-1209

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	DR. CANDIDA CASTILLO
Credential	:	DMD, CAGS
Telephone Number	:	401-232-7777

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	12/23/2010

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