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General NPI Number Information
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NPI Number | 1508396037
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Entity Type | Individual
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Provider Name | JAY CASTLE DDS
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Gender | Male
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 3210 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503
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Country | US
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Telephone | 903-832-3146
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Fax | 903-838-2579
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Provider Business Mailing Address
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Address Line | 3210 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0702
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Country | US
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Telephone | 903-832-3146
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Fax | 903-838-2579
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4175
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33979
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License Number State | TX
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