Provider Demographics
NPI:1093325615
Name:CASTELL, IAN ADAN (DDS)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:ADAN
Last Name:CASTELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3353 OBSIDIAN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-7427
Mailing Address - Country:US
Mailing Address - Phone:956-465-6321
Mailing Address - Fax:
Practice Address - Street 1:1205 E ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3831
Practice Address - Country:US
Practice Address - Phone:956-542-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice