Organization
MID OHIO DENTAL ASSOCIATES
Active
Other names
Mid Ohio Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JACK DANIEL CASTILLA DDS (DENTIST)
(614) 279-9204
Entity
Organization
Contact information
Practice address
3079 W. BROAD STE SUITE 7, COLUMBUS, OH 43204
(614) 279-9204
(614) 279-9208
Mailing address
3079 W. BROAD STE SUITE 7, COLUMBUS, OH 43204
(614) 279-9204
(614) 279-9208
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30016727
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2210039
—
OH
01
—
9180566
MOLINA HEALTH
OH
Enumeration date
08/30/2006
Last updated
09/02/2025
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