Provider Demographics
NPI:1205990686
Name:CASTELLANO, DAVID LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:CASTELLANO
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 1:12229 W. LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:813-475-4528
Mailing Address - Fax:813-475-4247
Practice Address - Street 1:12229 W. LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:813-884-4641
Practice Address - Fax:813-887-1937
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist