Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 30.018626 | OH |
NPI | 1043462849 |
---|---|
Provider Name | Dr. Marcus Castro |
First Address | Beachwood, OH 44122-4465 |
Second Address | Beachwood, OH 44122-4465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2008 |
Last Update Date | 13/10/2008 |