Provider Demographics
NPI:1285878587
Name:OPTIMUM DENTAL CARE, CSP
Entity type:Organization
Organization Name:OPTIMUM DENTAL CARE, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ITHAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-783-6698
Mailing Address - Street 1:107 AVE ORTEGON STE 202
Mailing Address - Street 2:CAPARRA GALLERY BUILDING
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2517
Mailing Address - Country:US
Mailing Address - Phone:787-783-6698
Mailing Address - Fax:787-793-3105
Practice Address - Street 1:107 AVE ORTEGON STE 202
Practice Address - Street 2:CAPARRA GALLERY BUILDING
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2517
Practice Address - Country:US
Practice Address - Phone:787-783-6698
Practice Address - Fax:787-793-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty