Provider Demographics
NPI:1396406476
Name:CASTILLO, LEONARDO MIGUEL BACHOCO (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO MIGUEL
Middle Name:BACHOCO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 W SAHARA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2828
Mailing Address - Country:US
Mailing Address - Phone:630-732-1707
Mailing Address - Fax:
Practice Address - Street 1:7135 W SAHARA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2828
Practice Address - Country:US
Practice Address - Phone:702-872-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034052122300000X
390200000X
IN12013892A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program