Provider Demographics
NPI:1477181410
Name:CASTELLANOS DDS INC
Entity Type:Organization
Organization Name:CASTELLANOS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:CASTELLANOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-822-6200
Mailing Address - Street 1:9725 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6716
Mailing Address - Country:US
Mailing Address - Phone:909-822-6200
Mailing Address - Fax:909-822-6222
Practice Address - Street 1:9725 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6716
Practice Address - Country:US
Practice Address - Phone:909-822-6200
Practice Address - Fax:909-822-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty