Healthcare Provider Details

I. General information

NPI: 1538095674
Provider Name (Legal Business Name): CAROLINA GUILLEN DEL CASTILLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SOUTHTOWNE DR
POTOSI MO
63664-5729
US

IV. Provider business mailing address

210 S 12TH ST APT 11P
PHILADELPHIA PA
19107-6324
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026025180
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: