Provider Demographics
NPI:1386823508
Name:JAIRO CASTRO, D.D.S., INC.
Entity Type:Organization
Organization Name:JAIRO CASTRO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-263-2228
Mailing Address - Street 1:2703 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1441
Mailing Address - Country:US
Mailing Address - Phone:323-263-2228
Mailing Address - Fax:323-263-2227
Practice Address - Street 1:2703 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1441
Practice Address - Country:US
Practice Address - Phone:323-263-2228
Practice Address - Fax:323-263-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAIRO CASTRO, D.D.S., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA523511Medicare PIN