Provider Demographics
NPI:1235149204
Name:CASTRO, CHRISTINE GONZALES (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GONZALES
Last Name:CASTRO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CASTRO-LICUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 BIRMINGHAM DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1744
Mailing Address - Country:US
Mailing Address - Phone:760-944-1041
Mailing Address - Fax:760-944-1074
Practice Address - Street 1:120 BIRMINGHAM DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1744
Practice Address - Country:US
Practice Address - Phone:760-944-1041
Practice Address - Fax:760-944-1074
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43132122300000X
CA43121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist