MEDICARE: WAYNE W CASTLE DDS PC

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	H-D-1-00630	CO

General Provider Information

NPI Number	:	1356343164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE W CASTLE DDS PC

Provider Business Mailing Address
First Line	:	1361 FRANCIS ST
Second Line	:	STE 202
City	:	LONGMONT
State	:	CO
Zip	:	80501-2576
Country	:	US
Telephone Number	:	303-772-8020
Fax Number	:	303-772-1525

Provider Business Practice Location Address
First Line	:	1361 FRANCIS ST
Second Line	:	STE 202
City	:	LONGMONT
State	:	CO
Zip	:	80501-2576
Country	:	US
Telephone Number	:	303-772-8020
Fax Number	:	303-772-1525

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. WAYNE WILLIAM CASTLE
Credential	:	DDS
Telephone Number	:	303-772-8020

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/22/2020

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