Provider Demographics
NPI:1285768614
Name:CASTILLON, ANTHONY BRYCE (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BRYCE
Last Name:CASTILLON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N 1ST EAST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-4247
Mailing Address - Country:US
Mailing Address - Phone:307-875-6000
Mailing Address - Fax:307-875-3398
Practice Address - Street 1:400 N 1ST EAST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-4247
Practice Address - Country:US
Practice Address - Phone:307-875-6000
Practice Address - Fax:307-875-3398
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice