Provider Demographics
NPI:1396251922
Name:CASTILLO RINCON, HAIVY LORI (DMD)
Entity type:Individual
Prefix:DR
First Name:HAIVY
Middle Name:LORI
Last Name:CASTILLO RINCON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 STRAWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-2601
Mailing Address - Country:US
Mailing Address - Phone:630-886-1582
Mailing Address - Fax:773-202-0310
Practice Address - Street 1:1319 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2601
Practice Address - Country:US
Practice Address - Phone:281-571-3700
Practice Address - Fax:346-204-5982
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190312391223G0001X
TX391811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice