Provider Demographics
NPI:1184275471
Name:RODRIGUEZ CASTILLO, RONNY
Entity type:Individual
Prefix:
First Name:RONNY
Middle Name:
Last Name:RODRIGUEZ CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 25TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1328
Mailing Address - Country:US
Mailing Address - Phone:406-248-6177
Mailing Address - Fax:406-248-1556
Practice Address - Street 1:315 N 25TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1328
Practice Address - Country:US
Practice Address - Phone:406-248-6177
Practice Address - Fax:406-248-1556
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19402122300000X
MND14315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist