Provider Demographics
NPI:1346459294
Name:CASTILLO, JOHN RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:CASTILLO
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 1:27725 SANTA MARGARITA PKWY
Mailing Address - Street 2:STE 241
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6704
Mailing Address - Country:US
Mailing Address - Phone:949-215-7730
Mailing Address - Fax:949-859-1318
Practice Address - Street 1:27725 SANTA MARGARITA PKWY
Practice Address - Street 2:STE 241
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6704
Practice Address - Country:US
Practice Address - Phone:949-215-7730
Practice Address - Fax:949-859-1318
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice