1184705832 NPI number — DR. GLEN THOMAS CASTO DDS

Table of content: DR. GLEN THOMAS CASTO DDS (NPI 1184705832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184705832 NPI number — DR. GLEN THOMAS CASTO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTO
Provider First Name:
GLEN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184705832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8306 SE SANCTUARY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBE SOUND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33455-3960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-546-8784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
NORTH PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-3879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-624-2047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  DN16640 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114582300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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