Healthcare Provider Details

I. General information

NPI: 1770681082
Provider Name (Legal Business Name): ROBERT A DEL CASTILLO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 NW 146TH ST SUITE #104
MIAMI LAKES FL
33016-1581
US

IV. Provider business mailing address

7735 NW 146TH ST SUITE #104
MIAMI LAKES FL
33016-1581
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-7010
  • Fax: 305-231-3984
Mailing address:
  • Phone: 305-556-7010
  • Fax: 305-231-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN 10740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: