Provider Demographics
NPI:1295799435
Name:CASTILLO, JOSE J (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800512
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0512
Mailing Address - Country:US
Mailing Address - Phone:787-841-7905
Mailing Address - Fax:787-844-3224
Practice Address - Street 1:34 CALLE CENTRAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2112
Practice Address - Country:US
Practice Address - Phone:787-848-3892
Practice Address - Fax:787-844-3224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist