Provider Demographics
NPI:1114465911
Name:GUILLERMO S. CASTILLO DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:GUILLERMO S. CASTILLO DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDIANTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GABY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-244-1111
Mailing Address - Street 1:15278 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3300
Mailing Address - Country:US
Mailing Address - Phone:760-244-1111
Mailing Address - Fax:760-244-1877
Practice Address - Street 1:15278 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3300
Practice Address - Country:US
Practice Address - Phone:760-244-1111
Practice Address - Fax:760-244-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty