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General NPI Number Information
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NPI Number | 1265580302
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Entity Type | Individual
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Provider Name | CANDIDA CASTILLO DMD,
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 129 LINCOLN ST
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City | WORCESTER
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State | MA
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Zip | 01605-2402
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Country | US
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Telephone | 508-754-2751
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BANGOR ST
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City | WORCESTER
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State | MA
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Zip | 01604-2302
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Country | US
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Telephone | 617-835-2275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21501
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License Number State | MA
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