Provider Demographics
NPI:1457762585
Name:EL KHOULY CASTILLA, ISMAEL (DDS, MS, PHD)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:EL KHOULY CASTILLA
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 FIRST AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5629
Mailing Address - Country:US
Mailing Address - Phone:703-585-0172
Mailing Address - Fax:
Practice Address - Street 1:421 FIRST AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5629
Practice Address - Country:US
Practice Address - Phone:212-998-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19832122300000X
CT11122122300000X
NY000050-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist