Healthcare Provider Details

I. General information

NPI: 1669060554
Provider Name (Legal Business Name): MARIAN CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 E FLAMINGO RD
LAS VEGAS NV
89119-5117
US

IV. Provider business mailing address

6471 AMERICAN EAGLE AVE
LAS VEGAS NV
89131-3252
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8453
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: