Provider Demographics
NPI:1396406476
Name:CASTILLO, LEONARDO MIGUEL BACHOCO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO MIGUEL
Middle Name:BACHOCO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 CHERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3359
Mailing Address - Country:US
Mailing Address - Phone:562-650-0741
Mailing Address - Fax:
Practice Address - Street 1:3775 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2909
Practice Address - Country:US
Practice Address - Phone:847-623-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034052122300000X
390200000X
IN12013892A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program