Provider Demographics
NPI:1659816429
Name:GUSTAVO RUIZ DE CASTILLA DMD PA
Entity Type:Organization
Organization Name:GUSTAVO RUIZ DE CASTILLA DMD PA
Other - Org Name:PERIODONTAL & IMPLANT ESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ DE CASTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-289-3640
Mailing Address - Street 1:3814 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3922
Mailing Address - Country:US
Mailing Address - Phone:813-289-3640
Mailing Address - Fax:813-872-0170
Practice Address - Street 1:3814 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3922
Practice Address - Country:US
Practice Address - Phone:813-289-3640
Practice Address - Fax:813-872-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty