Individual provider Active NPI

Gail Castillo Deguzman, DDS

  • General Practice Dentistry
  • Lake Worth, TX
National Provider Identifier
1588046189
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
32370 Issued in TX
Practice address
6076 Azle Ave
Lake Worth, TX 76135-2603
Phone
(817) 238-6222
Fax
(817) 237-2712
NPI assigned
Jun 19, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X LL762 MD
General Practice Dentistry 1223G0001X 32370 TX Primary

Addresses

Primary practice location

6076 Azle Ave
Lake Worth, TX 76135-2603

Mailing address

PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015

Other practice location 1

12165 Elm St
Princess Anne, MD 21853-1358
Phone (410) 651-5151

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LL762MDMDGeneral Practice Dentistry
32370TXMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1588046189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6076 AZLE AVE",
            "city": "LAKE WORTH",
            "state": "TX",
            "postal_code": "761352603",
            "telephone_number": "817-238-6222",
            "fax_number": "817-237-2712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12165 Elm St",
            "address_purpose": "LOCATION",
            "city": "Princess Anne",
            "state": "MD",
            "postal_code": "218531358",
            "country_code": "US",
            "telephone_number": "410-651-5151",
            "fax_number": "410-651-4256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEGUZMAN",
        "first_name": "GAIL",
        "middle_name": "CASTILLO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "LL762",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "32370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.