Provider Demographics
NPI:1003916818
Name:CASTILLO, GUILLERMO SALVADOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:SALVADOR
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E FLORIDA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4530
Mailing Address - Country:US
Mailing Address - Phone:951-652-1312
Mailing Address - Fax:951-652-0771
Practice Address - Street 1:930 E FLORIDA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4530
Practice Address - Country:US
Practice Address - Phone:951-652-1312
Practice Address - Fax:951-652-0771
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 94099-01Medicaid
CAG 94099-01Medicaid