Provider Demographics
NPI:1659858736
Name:JAY J CASTLE DDS PLLC
Entity Type:Organization
Organization Name:JAY J CASTLE DDS PLLC
Other - Org Name:CASTLE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-824-4321
Mailing Address - Street 1:3210 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0702
Mailing Address - Country:US
Mailing Address - Phone:903-832-3146
Mailing Address - Fax:903-838-2579
Practice Address - Street 1:3210 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0702
Practice Address - Country:US
Practice Address - Phone:903-832-3146
Practice Address - Fax:903-838-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33979261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508396037OtherNPI
1194868513OtherNPI