Provider Demographics
NPI:1992375588
Name:CASTLE PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:CASTLE PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:
Authorized Official - Last Name:E CASTELLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-383-6738
Mailing Address - Street 1:1660 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4906
Mailing Address - Country:US
Mailing Address - Phone:407-383-6738
Mailing Address - Fax:
Practice Address - Street 1:5745 CANTON CV STE 101
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5012
Practice Address - Country:US
Practice Address - Phone:407-755-4119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty