| Doctor Name: | GLEN M CASTOR |
| NPI Number: | 1013151083 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LD |
| License Number: | LD-53 |
| Business Practice Address: | 306 12th Ave S Nampa, ID - 836514246 |
| Business Phone Number: | 2084664205 |
| Business Fax Number: | |
| Mailing Address: | 306 12th Ave S, NAMPA |
| State: | ID |
| Postal Code: | 836514246 |
| Phone Number: | 2084664205 |
| Fax Number: | |
| NPI Enumeration Date: | 04/21/2009 |
| NPI Last Update Date: | 04/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | LD-53 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |