Individual
DR. JACK DANIEL CASTILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1206 W BROAD ST, COLUMBUS, OH 43222-1319
(614) 279-9204
(614) 279-9208
Mailing address
1206 W BROAD ST, COLUMBUS, OH 43222-1319
(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
Enumeration date
12/14/2009
Last updated
07/18/2013
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