Provider Demographics
NPI:1841529328
Name:CAST, DOUGLAS (DDS, FAGD, DIADI)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:CAST
Suffix:
Gender:M
Credentials:DDS, FAGD, DIADI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74120 EL PASEO STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4120
Mailing Address - Country:US
Mailing Address - Phone:760-301-5252
Mailing Address - Fax:442-274-2539
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS ROAD
Practice Address - Street 2:D-150
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-698-1700
Practice Address - Fax:951-848-0758
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice