Provider Demographics
NPI:1629528542
Name:MARIO J CASTELLANOS JR DDS INC
Entity Type:Organization
Organization Name:MARIO J CASTELLANOS JR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTELLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-765-2040
Mailing Address - Street 1:2063 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4730
Mailing Address - Country:US
Mailing Address - Phone:951-765-2040
Mailing Address - Fax:951-765-2044
Practice Address - Street 1:2063 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4730
Practice Address - Country:US
Practice Address - Phone:951-765-2040
Practice Address - Fax:951-765-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60364261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental