Provider Demographics
NPI:1639283872
Name:CASTILLO, MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 N LOOP 1604 W STE 207
Mailing Address - Street 2:HAPPY PEDIATRIC DENTISTRY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1479
Mailing Address - Country:US
Mailing Address - Phone:210-510-2862
Mailing Address - Fax:210-802-4499
Practice Address - Street 1:2602 N LOOP 1604 W STE 207
Practice Address - Street 2:HAPPY PEDIATRIC DENTISTRY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1479
Practice Address - Country:US
Practice Address - Phone:210-510-2862
Practice Address - Fax:210-802-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX237051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2049744Medicaid