Provider Demographics
NPI:1427080605
Name:CASTILLO, CANDACE A (DDS)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3294 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3082
Mailing Address - Country:US
Mailing Address - Phone:770-448-8882
Mailing Address - Fax:770-446-5511
Practice Address - Street 1:3294 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3082
Practice Address - Country:US
Practice Address - Phone:770-448-8882
Practice Address - Fax:770-446-5511
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics