Individual
JACOB I DIAZ-CASTANEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1386 GRAY HWY, MACON, GA 31211-1952
(478) 992-1500
Mailing address
4358 RIVERSIDE DR APT 1301, MACON, GA 31210-1783
(850) 737-1271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401419527
VA
1223G0001X
General Practice Dentistry
Primary
DN123923
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/13/2025
Last updated
04/21/2026
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