Provider Demographics
NPI:1578659488
Name:CASTOR, MARK S (DDS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:CASTOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:SUITE A207
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6888
Mailing Address - Country:US
Mailing Address - Phone:512-441-7777
Mailing Address - Fax:512-441-7632
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE A207
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6888
Practice Address - Country:US
Practice Address - Phone:512-441-7777
Practice Address - Fax:512-441-7632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX128061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice