Provider Demographics
NPI:1366012965
Name:CASTRO TIGRE, JHONNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JHONNY
Middle Name:
Last Name:CASTRO TIGRE
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 1:4160 HIGHLAND AVE STE J
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2750
Mailing Address - Country:US
Mailing Address - Phone:909-281-8200
Mailing Address - Fax:
Practice Address - Street 1:4160 HIGHLAND AVE STE J
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2750
Practice Address - Country:US
Practice Address - Phone:909-281-8200
Practice Address - Fax:909-281-8222
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002671-15122300000X
CA1083571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist