Provider Demographics
NPI:1942423918
Name:CASTAIC DENTAL CENTER
Entity Type:Organization
Organization Name:CASTAIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:EKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-259-5540
Mailing Address - Street 1:21700 W GOLDEN TRIANGLE RD
Mailing Address - Street 2:#201
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350
Mailing Address - Country:US
Mailing Address - Phone:661-259-5540
Mailing Address - Fax:661-259-5571
Practice Address - Street 1:31886 N CASTAIC RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384
Practice Address - Country:US
Practice Address - Phone:661-257-2300
Practice Address - Fax:661-257-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty