MEDICARE: DR. LUIS ROBERTO FRANCO CASTELLANOS D.D.S.

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	122300000X	Dentist	50254	CA

General Provider Information

NPI Number	:	1730181587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ROBERTO FRANCO CASTELLANOS D.D.S.

Provider Business Mailing Address
First Line	:	6318 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4102
Country	:	US
Telephone Number	:	323-588-4869
Fax Number	:	323-588-2839

Provider Business Practice Location Address
First Line	:	6318 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4102
Country	:	US
Telephone Number	:	323-588-4869
Fax Number	:	323-588-2839

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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