| Luis Castillo Professional Dental Corporation | |
|
5359 N Fresno St Ste 110f Fresno CA 93710-6864 | |
| (559) 221-0302 | |
| (559) 221-0302 |
| Full Name | Luis Castillo Professional Dental Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 5359 N Fresno St Ste 110f, Fresno, California |
| Authorized Official Name and Position | Annette Castillo (SECRETARY) |
| Authorized Official Contact | 5592210302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luis Castillo Professional Dental Corporation 5359 N Fresno St Ste 110f Fresno CA 93710-6864 Ph: () - | Luis Castillo Professional Dental Corporation 5359 N Fresno St Ste 110f Fresno CA 93710-6864 Ph: (559) 221-0302 |
| NPI Number | 1700305802 |
|---|---|
| Provider Enumeration Date | 09/11/2017 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 3577995786 |
|---|---|
| Medicare Enrollment ID | O20191108001777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700305802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 45659 (California) | Primary |
| Provider Name | Luis F Castillo |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1265501415 PECOS PAC ID: 7416382817 Enrollment ID: I20200113001774 |
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