Healthcare Provider Details

I. General information

NPI: 1245406511
Provider Name (Legal Business Name): ROGER J CASTRO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 CENTRAL PARK BLVD UNIT 305
DENVER CO
80238-2301
US

IV. Provider business mailing address

2373 CENTRAL PARK BLVD UNIT 305
DENVER CO
80238-2301
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-5437
  • Fax: 303-399-5445
Mailing address:
  • Phone: 303-399-5437
  • Fax: 303-399-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberP58817
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN00203398
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: