Healthcare Provider Details

I. General information

NPI: 1710272349
Provider Name (Legal Business Name): CASTOR DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7258 CASTOR AVE
PHILADELPHIA PA
19149-1109
US

IV. Provider business mailing address

7258 CASTOR AVE
PHILADELPHIA PA
19149-1109
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-1144
  • Fax: 215-728-1363
Mailing address:
  • Phone: 215-728-1144
  • Fax: 215-728-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037847
License Number StatePA

VIII. Authorized Official

Name: RAKESH PATEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 215-728-1144