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General NPI Number Information
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NPI Number | 1962654889
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Entity Type | Individual
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Provider Name | MARK J CASTLE DDS
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Gender | Male
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 2700 S WOODLANDS VILLAGE BLVD SUITE 390
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-7114
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Country | US
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Telephone | 928-226-7654
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Fax | 928-226-7373
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Provider Business Mailing Address
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Address Line | 138 CELILO ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-9531
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Country | US
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Telephone | 928-525-9263
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Fax | 928-525-9338
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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 | D2897
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License Number State | AZ
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