Provider Demographics
NPI:1043430382
Name:CASTILLE AND CASTILLE DDS PC
Entity Type:Organization
Organization Name:CASTILLE AND CASTILLE DDS PC
Other - Org Name:DR M GERARD CASTILLE AND DR CYNTHIA R CASTILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OFFICER OF THE CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:REICHARD
Authorized Official - Last Name:CASTILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-332-5561
Mailing Address - Street 1:1001 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:281-332-5561
Mailing Address - Fax:281-332-2926
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-332-5561
Practice Address - Fax:832-632-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 14291122300000X
TXTX 13444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81D752OtherBLUE CROSS BLUE SHIELD
TX81D751OtherBLUE CROSS BLUE SHIELD