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General NPI Number Information
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NPI Number | 1356391817
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Entity Type | Individual
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Provider Name | JOHN MICHAEL CASTOR D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 168 SAGAMORE PKWY W
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1569
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Country | US
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Telephone | 765-497-3967
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Fax |
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Provider Business Mailing Address
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Address Line | 168 SAGAMORE PKWY W
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1569
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Country | US
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Telephone | 765-497-3967
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12008298
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License Number State | IN
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