Individual
MRS. JORDAN ANTONISSE CASTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
8200 DODGE ST, OMAHA, NE 68114-4113
(402) 552-7267
Mailing address
4508 NE 85TH ST, KANSAS CITY, MO 64156-7802
(214) 535-1488
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2017000011
MO
Other
Enumeration date
06/25/2015
Last updated
07/21/2022
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