Healthcare Provider Details

I. General information

NPI: 1790806958
Provider Name (Legal Business Name): ANA E CASTILLA DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 LANCASTER DR NE
SALEM OR
97301-4728
US

IV. Provider business mailing address

434 LANCASTER DR NE
SALEM OR
97301-4728
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-0721
  • Fax: 503-399-8583
Mailing address:
  • Phone: 503-399-0721
  • Fax: 503-399-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD9838
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: