Individual
GLEN M CASTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
306 12TH AVE S, NAMPA, ID 83651-4246
(208) 466-4205
Mailing address
306 12TH AVE S, NAMPA, ID 83651-4246
(208) 466-4205
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
LD-53
ID
Other
Enumeration date
04/21/2009
Last updated
04/21/2009
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