Provider Demographics
NPI:1316958168
Name:CASTLEBERRY, DARRICK LAVONE SR (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRICK
Middle Name:LAVONE
Last Name:CASTLEBERRY
Suffix:SR
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 1:4429 GRIGGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2852
Mailing Address - Country:US
Mailing Address - Phone:713-842-2500
Mailing Address - Fax:713-842-4224
Practice Address - Street 1:4429 GRIGGS RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2852
Practice Address - Country:US
Practice Address - Phone:713-842-2500
Practice Address - Fax:713-842-4224
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090849313Medicaid