Healthcare Provider Details

I. General information

NPI: 1093395436
Provider Name (Legal Business Name): CASTRO DENTAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 HARTNELL AVE STE A
REDDING CA
96002-2325
US

IV. Provider business mailing address

2411 HARTNELL AVE STE A
REDDING CA
96002-2325
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-3500
  • Fax: 530-244-2807
Mailing address:
  • Phone: 530-244-3500
  • Fax: 530-244-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MS. JAMIE CASTRO
Title or Position: BUSINESS MGR
Credential:
Phone: 530-898-1234