Healthcare Provider Details

I. General information

NPI: 1174460984
Provider Name (Legal Business Name): OLGA IVETT CASTRO, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HIGHWAY 61 N STE 200
WHITE BEAR LAKE MN
55110-2752
US

IV. Provider business mailing address

4801 HIGHWAY 61 N STE 200
WHITE BEAR LAKE MN
55110-2752
US

V. Phone/Fax

Practice location:
  • Phone: 651-429-3535
  • Fax: 651-429-9630
Mailing address:
  • Phone: 651-429-3535
  • Fax: 651-429-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. OLGA I CASTRO
Title or Position: PRESIDENT
Credential: DDS
Phone: 651-429-3535