Provider Demographics
NPI:1659095495
Name:GERMANTOWN FAMILY DENTAL
Entity type:Organization
Organization Name:GERMANTOWN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR CONTRACTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-732-1504
Mailing Address - Street 1:102 DEES DRIVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-381-8200
Mailing Address - Fax:601-381-8255
Practice Address - Street 1:102 DEES DRIVE
Practice Address - Street 2:SUITE M
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-381-8200
Practice Address - Fax:601-381-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental