Provider Demographics
NPI:1407258411
Name:DEER CREEK DENTAL LLC
Entity Type:Organization
Organization Name:DEER CREEK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-268-9030
Mailing Address - Street 1:425 W ROCKRIMMON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1774
Mailing Address - Country:US
Mailing Address - Phone:719-268-9030
Mailing Address - Fax:
Practice Address - Street 1:425 W ROCKRIMMON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1774
Practice Address - Country:US
Practice Address - Phone:719-268-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty