Provider Demographics
NPI:1609925304
Name:MARTINEZ CASTILLO, LUCILA CARDENAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCILA
Middle Name:CARDENAS
Last Name:MARTINEZ CASTILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LUCITA
Other - Middle Name:CARDENAS
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2104 JOLLY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6038
Mailing Address - Country:US
Mailing Address - Phone:517-381-9999
Mailing Address - Fax:517-381-0920
Practice Address - Street 1:2104 JOLLY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6038
Practice Address - Country:US
Practice Address - Phone:517-381-9999
Practice Address - Fax:517-381-0920
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010170261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice