Provider Demographics
NPI:1003445560
Name:JAMES C. CASTELO, DDS, INC.
Entity Type:Organization
Organization Name:JAMES C. CASTELO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHAN
Authorized Official - Last Name:CASTELO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-666-3852
Mailing Address - Street 1:5250 SANTA MONICA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1254
Mailing Address - Country:US
Mailing Address - Phone:323-666-3852
Mailing Address - Fax:
Practice Address - Street 1:5250 SANTA MONICA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1254
Practice Address - Country:US
Practice Address - Phone:323-666-3852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144467341OtherNPI TYPE1