Provider Demographics
NPI:1386868990
Name:CASTLEHILL DENTAL PC
Entity type:Organization
Organization Name:CASTLEHILL DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-824-1122
Mailing Address - Street 1:735 CASTLE HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1329
Mailing Address - Country:US
Mailing Address - Phone:718-824-1122
Mailing Address - Fax:718-931-0112
Practice Address - Street 1:735 CASTLE HILL AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1329
Practice Address - Country:US
Practice Address - Phone:718-824-1122
Practice Address - Fax:718-931-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02010126Medicaid