Healthcare Provider Details

I. General information

NPI: 1932753001
Provider Name (Legal Business Name): LUCAS CASTILLO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 W COLORADO AVE
COLORADO SPRINGS CO
80904-2040
US

IV. Provider business mailing address

3113 W COLORADO AVE
COLORADO SPRINGS CO
80904-2040
US

V. Phone/Fax

Practice location:
  • Phone: 901-413-3685
  • Fax:
Mailing address:
  • Phone: 901-413-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUCAS RAMON CASTILLO
Title or Position: DENTIST
Credential: DDS
Phone: 901-413-3685