MEDICARE: DR. GAIL CASTILLO DEGUZMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	LL762	MD
2	1223G0001X	General Practice Dentistry	32370	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588046189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL CASTILLO DEGUZMAN DDS

Provider Business Mailing Address
First Line	:	PO BOX 1978
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21802-1978
Country	:	US
Telephone Number	:	410-749-1015
Fax Number	:	410-749-0654

Provider Business Practice Location Address
First Line	:	6076 AZLE AVE
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2603
Country	:	US
Telephone Number	:	817-238-6222
Fax Number	:	817-237-2712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	07/21/2022

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