Provider Demographics
NPI:1700947983
Name:LARA, FLORA CASTILLO (DDS)
Entity Type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:CASTILLO
Last Name:LARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10343 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-869-3443
Mailing Address - Fax:562-869-6663
Practice Address - Street 1:10343 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-869-3443
Practice Address - Fax:562-869-6663
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD43454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist