Provider Demographics
NPI:1710261755
Name:CASTILLE, M. GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:GERARD
Last Name:CASTILLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MERLIN
Other - Middle Name:GERARD
Other - Last Name:CASTILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1001 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2021
Mailing Address - Country:US
Mailing Address - Phone:281-332-5561
Mailing Address - Fax:832-632-2506
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2021
Practice Address - Country:US
Practice Address - Phone:281-332-5561
Practice Address - Fax:832-632-2506
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice