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General NPI Number Information
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NPI Number | 1609993757
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Entity Type | Organization
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Legal Business Name | CARLOS CASTRO-B., D.M.D.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 BROOKLINE PL SUITE 420
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City | BROOKLINE
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State | MA
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Zip | 02445-7224
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Country | US
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Telephone | 617-277-9800
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Fax | 617-277-5396
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Provider Business Mailing Address
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Address Line | 1 BROOKLINE PL SUITE 420
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City | BROOKLINE
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State | MA
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Zip | 02445-7224
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Country | US
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Telephone | 617-277-9800
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Fax | 617-277-5396
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLOS CASTRO-BARRERA
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Credential | D.M.D.
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Telephone | 617-277-9800
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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 | 17964
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License Number State | MA
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