MEDICARE: DR. ERIC G CASTRODAD ORTIZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1705	PR

General Provider Information

NPI Number	:	1003812603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC G CASTRODAD ORTIZ DMD

Provider Business Mailing Address
First Line	:	ANTONIO BARCELO STREET #35
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739
Country	:	US
Telephone Number	:	787-739-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	ANTONIO BARCELO #35 STREET
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739
Country	:	US
Telephone Number	:	787-739-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/01/2017

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