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Organization
PALM HARBOR PREMIER DENTAL, INC.
Active
Organization
PALM HARBOR PREMIER DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L CASTELLANO DMD (DENTIST/VICE-PRESIDENT)
(727) 249-0460
Entity
Organization
Contact information
Practice address
30685 US HIGHWAY 19 N, PALM HARBOR, FL 34684-4410
(727) 249-0460
(727) 216-6627
Mailing address
30685 US HIGHWAY 19 N, PALM HARBOR, FL 34684-4410
(727) 249-0460
(727) 216-6627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN15383
STATE DENTAL LICENSE
FL
01
—
DN17378
STATE DENTAL LICENSE
FL
Enumeration date
04/02/2022
Last updated
04/02/2022
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