Provider Demographics
NPI:1932753001
Name:LUCAS CASTILLO PC
Entity Type:Organization
Organization Name:LUCAS CASTILLO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-413-3685
Mailing Address - Street 1:3113 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2040
Mailing Address - Country:US
Mailing Address - Phone:901-413-3685
Mailing Address - Fax:
Practice Address - Street 1:3113 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2040
Practice Address - Country:US
Practice Address - Phone:901-413-3685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL CARE AT RED ROCK CANYON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55975364Medicaid