1699624940 NPI number — CASTROVILLE CHILDREN'S DENTAL ASSOCIATION PLLC

Table of content: (NPI 1699624940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699624940 NPI number — CASTROVILLE CHILDREN'S DENTAL ASSOCIATION PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTROVILLE CHILDREN'S DENTAL ASSOCIATION PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699624940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1762 HWY 90 E
Provider Second Line Business Mailing Address:
SUITE #103
Provider Business Mailing Address City Name:
CASTROVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78009-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-346-1420
Provider Business Mailing Address Fax Number:
830-346-1421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1762 HWY 90 E
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
CASTROVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78009-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-346-1420
Provider Business Practice Location Address Fax Number:
830-346-1421
Provider Enumeration Date:
01/28/2026

Additional Information

Authorized Official

Authorized Official Last Name:
WEISMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ANALYTICS MGR
Authorized Official Telephone Number:
972-369-2226

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com