Provider Demographics
NPI:1083463061
Name:CASTRO GUERRERO, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:CASTRO GUERRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 NW 107TH AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3830
Mailing Address - Country:US
Mailing Address - Phone:305-226-1894
Mailing Address - Fax:
Practice Address - Street 1:5232 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9347
Practice Address - Country:US
Practice Address - Phone:803-626-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist