MEDICARE: VINCENZO JOHN CASTALDO III 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	21103	CA

General Provider Information

NPI Number	:	1518016781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENZO JOHN CASTALDO III DMD

Provider Business Mailing Address
First Line	:	7601 HOSPITAL DR
Second Line	:	104B
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5408
Country	:	US
Telephone Number	:	916-423-4092
Fax Number	:	916-423-3125

Provider Business Practice Location Address
First Line	:	7601 HOSPITAL DR
Second Line	:	104B
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5408
Country	:	US
Telephone Number	:	916-423-4092
Fax Number	:	916-423-3125

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/08/2026

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