Provider Demographics
NPI:1720558166
Name:GUILLERMO SAL CASTILLO DENTAL CORP
Entity Type:Organization
Organization Name:GUILLERMO SAL CASTILLO DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-244-1111
Mailing Address - Street 1:4355 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6236
Mailing Address - Country:US
Mailing Address - Phone:323-357-7900
Mailing Address - Fax:
Practice Address - Street 1:4355 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6236
Practice Address - Country:US
Practice Address - Phone:323-357-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty