Healthcare Provider Details

I. General information

NPI: 1467198028
Provider Name (Legal Business Name): GIOVANNI CASTRO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409 NC HIGHWAY 305
JACKSON NC
27845-9679
US

IV. Provider business mailing address

PO BOX 640
ROANOKE RAPIDS NC
27870-0640
US

V. Phone/Fax

Practice location:
  • Phone: 252-536-5920
  • Fax: 252-519-0154
Mailing address:
  • Phone: 252-536-5844
  • Fax: 252-519-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number13265
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: