Provider Demographics
NPI:1356044309
Name:DEL CASTILLO, NIKKI JOSE (DDS)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:JOSE
Last Name:DEL CASTILLO
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W DAOG CT
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-5514
Mailing Address - Country:US
Mailing Address - Phone:671-686-5866
Mailing Address - Fax:
Practice Address - Street 1:505 HARMON LOOP RD STE 300
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6519
Practice Address - Country:US
Practice Address - Phone:671-637-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-3186122300000X
390200000X
GUD1058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program