Organization
KELLIE SMITH CASTRO DENTISTRY LLC
Active
Other names
Dentistry At The Mills
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE CASTRO DMD (OWNER/DENTIST)
(678) 226-9063
Entity
Organization
Contact information
Practice address
1860 DULUTH HWY STE 401, LAWRENCEVILLE, GA 30043-5061
(678) 226-9063
(678) 226-9445
Mailing address
1860 DULUTH HWY STE 401, LAWRENCEVILLE, GA 30043-5061
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015357
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619289246
N/A
NC
Enumeration date
10/30/2017
Last updated
10/30/2017
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