Provider Demographics
NPI:1376036756
Name:CASTANEDA ESCOBAR, LETICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:CASTANEDA ESCOBAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 S BUCKNER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6903
Mailing Address - Country:US
Mailing Address - Phone:469-879-5498
Mailing Address - Fax:
Practice Address - Street 1:2428 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-1106
Practice Address - Country:US
Practice Address - Phone:214-330-0222
Practice Address - Fax:214-330-0317
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice