Provider Demographics
NPI:1265543250
Name:CASTILLO, JORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N CAGE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-3109
Mailing Address - Country:US
Mailing Address - Phone:956-283-7919
Mailing Address - Fax:
Practice Address - Street 1:805 N CAGE BLVD
Practice Address - Street 2:STE D
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-283-7919
Practice Address - Fax:956-283-7886
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist