Provider Demographics
NPI:1457829459
Name:CASTILLO, RAMON D (DDS)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:D
Last Name:CASTILLO
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 1:38 VIA RICARDO
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-7001
Mailing Address - Country:US
Mailing Address - Phone:805-390-7831
Mailing Address - Fax:
Practice Address - Street 1:38 VIA RICARDO
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-7001
Practice Address - Country:US
Practice Address - Phone:805-390-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA122300000OtherDENTAL