Provider Demographics
NPI:1063611630
Name:CASTANEDA, MARIA C (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:C
Other - Last Name:CASTANEDA-NODARSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4751 GLENN PINE LANE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:786-266-0677
Mailing Address - Fax:561-499-1787
Practice Address - Street 1:16850 S JOG ROAD, SUITE 114-N
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-499-1788
Practice Address - Fax:561-499-1787
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166791223P0221X
FLDN 166791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty