Provider Demographics
NPI:1972714863
Name:CASTRO, EDITH JUNE (DDS)
Entity type:Individual
Prefix:DR
First Name:EDITH JUNE
Middle Name:
Last Name:CASTRO
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 1:2400 WESTBOROUGH BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5404
Mailing Address - Country:US
Mailing Address - Phone:650-952-4921
Mailing Address - Fax:650-952-4922
Practice Address - Street 1:2400 WESTBOROUGH BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080
Practice Address - Country:US
Practice Address - Phone:650-952-4921
Practice Address - Fax:650-952-4922
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice