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General NPI Number Information
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NPI Number | 1093395436
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Entity Type | Organization
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Legal Business Name | CASTRO DENTAL GROUP, PC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 2411 HARTNELL AVE STE A
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City | REDDING
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State | CA
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Zip | 96002-2325
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Country | US
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Telephone | 530-244-3500
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Fax | 530-244-2807
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Provider Business Mailing Address
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Address Line | 2411 HARTNELL AVE STE A
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City | REDDING
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State | CA
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Zip | 96002-2325
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Country | US
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Telephone | 530-244-3500
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Fax | 530-244-2807
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Authorized Official
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Title or Position | BUSINESS MGR
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Name | MS. JAMIE CASTRO
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Credential |
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Telephone | 530-898-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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