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NPI Code Detail

MEDICARE: DR. MATTHEW THEODORE CASTELE DMD

MEDICARE: DR. MATTHEW THEODORE CASTELE DMD
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
1122300000XDentistDS039655PA
21223D0004XDental Anesthesiology8748SC

General Provider Information

NPI Number : 1891135968
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW THEODORE CASTELE DMD
Provider Business Mailing Address
First Line : 4400 DORCHESTER RD
Second Line : SUITE 108
City : NORTH CHARLESTON
State : SC
Zip : 29405-6849
Country : US
Telephone Number : 864-249-0621
Fax Number : 412-937-9014
Provider Business Practice Location Address
First Line : 4400 DORCHESTER RD
Second Line : SUITE 108
City : NORTH CHARLESTON
State : SC
Zip : 29405-6849
Country : US
Telephone Number : 864-249-0621
Fax Number : 412-937-9014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2013
Last Update Date : 07/05/2016

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