Provider Demographics
NPI:1881114569
Name:CASTILLO, AMANDA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNN
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30875 INTERSTATE 10 W STE 200B
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9278
Mailing Address - Country:US
Mailing Address - Phone:830-368-4830
Mailing Address - Fax:830-368-4832
Practice Address - Street 1:30875 INTERSTATE 10 W STE 200B
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9278
Practice Address - Country:US
Practice Address - Phone:830-368-4830
Practice Address - Fax:830-368-4832
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001630-15122300000X
TX33960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFC6940414OtherDEA