Healthcare Provider Details

I. General information

NPI: 1306139514
Provider Name (Legal Business Name): GILBERTO JAVIER CASTILLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

IV. Provider business mailing address

PO BOX 3397
LAREDO TX
78044-3397
US

V. Phone/Fax

Practice location:
  • Phone: 956-718-6259
  • Fax: 956-718-6294
Mailing address:
  • Phone: 956-718-6259
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberF-26367
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: