Provider Demographics
NPI:1962553271
Name:CASTALDO, DOMINIC A (DDS)
Entity type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:A
Last Name:CASTALDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DOMINIC
Other - Middle Name:A
Other - Last Name:CASTALDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:120 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3000
Mailing Address - Country:US
Mailing Address - Phone:610-444-5042
Mailing Address - Fax:
Practice Address - Street 1:120 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3000
Practice Address - Country:US
Practice Address - Phone:610-444-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016128L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics