Provider Demographics
NPI:1285892711
Name:CHRISTINE TRACY G. CASTRO, DMD, INC.
Entity type:Organization
Organization Name:CHRISTINE TRACY G. CASTRO, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-719-1199
Mailing Address - Street 1:27365 JEFFERSON AVE
Mailing Address - Street 2:SUITE L & M
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5607
Mailing Address - Country:US
Mailing Address - Phone:951-719-1199
Mailing Address - Fax:951-719-3711
Practice Address - Street 1:27365 JEFFERSON AVE
Practice Address - Street 2:SUITE L & M
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5607
Practice Address - Country:US
Practice Address - Phone:951-719-1199
Practice Address - Fax:951-719-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty