Healthcare Provider Details

I. General information

NPI: 1184066466
Provider Name (Legal Business Name): CAS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRIV AMATISTA 573 VISTA HERMOSA
REYNOSA TAMAULIPAS
88500
MX

IV. Provider business mailing address

706 HIBISCUS AVE APT D
MCALLEN TX
78501-1984
US

V. Phone/Fax

Practice location:
  • Phone: 011528991280333
  • Fax:
Mailing address:
  • Phone: 956-874-5203
  • Fax: 956-424-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1102014
License Number StateZZ

VIII. Authorized Official

Name: FLORENTINO CASTILLO JR.
Title or Position: OWNER
Credential:
Phone: 956-874-5203