Healthcare Provider Details

I. General information

NPI: 1609118421
Provider Name (Legal Business Name): JO-ANN CASTELLONE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 ALBANY TPKE
CANTON CT
06019-2554
US

IV. Provider business mailing address

191 ALBANY TPKE PO BOX 456
CANTON CT
06019-2554
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-8314
  • Fax: 860-693-1079
Mailing address:
  • Phone: 860-693-0887
  • Fax: 860-693-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8384
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8384
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: