Provider Demographics
NPI:1679011472
Name:GUILLERMO S, CASTILLO DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:GUILLERMO S, CASTILLO DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-244-1111
Mailing Address - Street 1:15278 MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3300
Mailing Address - Country:US
Mailing Address - Phone:760-244-1111
Mailing Address - Fax:760-244-1877
Practice Address - Street 1:1030 E FOOTHILL BLVD # B-102
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4057
Practice Address - Country:US
Practice Address - Phone:909-981-3000
Practice Address - Fax:909-981-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty