Healthcare Provider Details

I. General information

NPI: 1801448527
Provider Name (Legal Business Name): EVAN COREY CASTILE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 25 MILE RD STE C
SHELBY TWP MI
48316-1904
US

IV. Provider business mailing address

8152 25 MILE RD STE C
SHELBY TWP MI
48316-1904
US

V. Phone/Fax

Practice location:
  • Phone: 586-992-9222
  • Fax:
Mailing address:
  • Phone: 586-747-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600209
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901600209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: