1578721627 NPI number — LOUIS J CASILLAS

Table of content: (NPI 1578721627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578721627 NPI number — LOUIS J CASILLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUIS J CASILLAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578721627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2248 N ALMA SCHOOL
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-899-9484
Provider Business Mailing Address Fax Number:
480-917-4780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2248 N ALMA SCHOOL
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-899-9484
Provider Business Practice Location Address Fax Number:
480-917-4780
Provider Enumeration Date:
05/27/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASILLAS
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
480-899-9484

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2730 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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