Healthcare Provider Details

I. General information

NPI: 1073631131
Provider Name (Legal Business Name): CASTILLO & MULKAY DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 CENTRAL AVE SUITE 204
UNION CITY NJ
07087-2423
US

IV. Provider business mailing address

7 CORN MILL CT
UPPER SADDLE RIVER NJ
07458-1232
US

V. Phone/Fax

Practice location:
  • Phone: 201-330-3333
  • Fax: 201-617-8210
Mailing address:
  • Phone: 201-825-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNJ

VIII. Authorized Official

Name: GUILLERMO RAFAEL CASTILLO
Title or Position: DENTIST
Credential: DMD
Phone: 201-330-3333