Healthcare Provider Details

I. General information

NPI: 1932739422
Provider Name (Legal Business Name): CASTILLO & VINCENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 HICKORY HOLLOW PKWY
ANTIOCH TN
37013-3003
US

IV. Provider business mailing address

5245 HICKORY HOLLOW PKWY
ANTIOCH TN
37013-3003
US

V. Phone/Fax

Practice location:
  • Phone: 615-866-9109
  • Fax:
Mailing address:
  • Phone: 615-866-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. FELIX VINCENT
Title or Position: OWNER/PARTNER
Credential: DDS
Phone: 615-866-9109