Provider Demographics
NPI:1326008145
Name:CASILLAS, LOUIS JOSEPH (DDS PC)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOSEPH
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 N. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-0248
Mailing Address - Country:US
Mailing Address - Phone:480-899-9484
Mailing Address - Fax:480-917-4780
Practice Address - Street 1:2248 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE #102
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2488
Practice Address - Country:US
Practice Address - Phone:480-899-9484
Practice Address - Fax:480-917-4780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice