Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS039655 | PA |
Y | 1223D0004X | Dentist Anesthesiologist | 8748 | SC |
NPI | 1891135968 |
---|---|
Provider Name | Dr. Matthew Theodore Castele |
First Address | North Charleston, SC 29405-6849 |
Second Address | North Charleston, SC 29405-6849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 05/07/2016 |