Provider Demographics
NPI:1255483665
Name:CASILLAS, ED (DDS)
Entity Type:Individual
Prefix:DR
First Name:ED
Middle Name:
Last Name:CASILLAS
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 1:3800 FAIRFAX DR
Mailing Address - Street 2:#6
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1711
Mailing Address - Country:US
Mailing Address - Phone:703-527-3477
Mailing Address - Fax:703-527-3489
Practice Address - Street 1:3800 FAIRFAX DR
Practice Address - Street 2:#6
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1711
Practice Address - Country:US
Practice Address - Phone:703-527-3477
Practice Address - Fax:703-527-3489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice