Healthcare Provider Details

I. General information

NPI: 1669900593
Provider Name (Legal Business Name): ERIC CASTLE DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 E CLARK AVE
ORCUTT CA
93455-5038
US

IV. Provider business mailing address

1070 E CLARK AVE
ORCUTT CA
93455-5038
US

V. Phone/Fax

Practice location:
  • Phone: 805-937-3003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number101359
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: