Provider Demographics
NPI:1679747802
Name:CASTILLO, DANIEL J (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10625 NORTH MILITARY TRL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6564
Mailing Address - Country:US
Mailing Address - Phone:561-691-6061
Mailing Address - Fax:561-691-6062
Practice Address - Street 1:10625 N MILITARY TRL
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6564
Practice Address - Country:US
Practice Address - Phone:561-691-6061
Practice Address - Fax:561-691-6062
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6507929011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice