Healthcare Provider Details

I. General information

NPI: 1073423455
Provider Name (Legal Business Name): MARISA CASTILLO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W WILSON ST
BATAVIA IL
60510-1946
US

IV. Provider business mailing address

20W550 GROVE ST
ITASCA IL
60143-2537
US

V. Phone/Fax

Practice location:
  • Phone: 630-879-1534
  • Fax:
Mailing address:
  • Phone: 708-980-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number028840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: