1063414274 NPI number — DR. MARY JANET CASTILLO ROLDAN D.D.S.

Table of content: DR. MARY JANET CASTILLO ROLDAN D.D.S. (NPI 1063414274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063414274 NPI number — DR. MARY JANET CASTILLO ROLDAN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLDAN
Provider First Name:
MARY JANET
Provider Middle Name:
CASTILLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTILLO
Provider Other First Name:
MARY JANET
Provider Other Middle Name:
FLORES
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063414274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10408 MALAGUENA CT.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-703-5564
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4921 CALLOWAY DR
Provider Second Line Business Practice Location Address:
STE. G-102
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312-9716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-369-8989
Provider Business Practice Location Address Fax Number:
661-369-8988
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  50897 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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