Provider Demographics
NPI:1629253042
Name:LINCOLN, ROSARIO CASTILLO (DDS)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:CASTILLO
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11327 LINARES ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1021
Mailing Address - Country:US
Mailing Address - Phone:858-672-1333
Mailing Address - Fax:
Practice Address - Street 1:340 E 8TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2359
Practice Address - Country:US
Practice Address - Phone:619-477-7770
Practice Address - Fax:619-477-7775
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice