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1001 W Main St League City TX 77573 | |
| (281) 332-5561 | |
| (832) 632-2506 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1001 W Main St, League City, Texas |
| Authorized Official Name and Position | Cynthia Reichard Castille (DENTIST OFFICER OF THE CORPORATION) |
| Authorized Official Contact | 2813325561 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1001 W Main St League City TX 77573 Ph: (281) 332-5561 | 1001 W Main St League City TX 77573 Ph: (281) 332-5561 |
| NPI Number | 1043430382 |
|---|---|
| Provider Enumeration Date | 04/27/2007 |
| Last Update Date | 10/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043430382 | NPI | - | NPPES |
| 81D752 | Other | TX | BLUE CROSS BLUE SHIELD |
| 81D751 | Other | TX | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | TX 14291 (Texas) | Secondary |
| 122300000X | Dentist | TX 13444 (Texas) | Primary |
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