Healthcare Provider Details

I. General information

NPI: 1891223129
Provider Name (Legal Business Name): ADRIANNE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 07/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 STAPLES MILL ROAD
GLEN ALLEN VA
23060
US

IV. Provider business mailing address

1612 HUGUENOT ROAD
MIDLOTHIAN VA
23113
US

V. Phone/Fax

Practice location:
  • Phone: 804-672-4900
  • Fax:
Mailing address:
  • Phone: 804-794-9789
  • Fax: 804-419-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401418033
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-10949
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: