Healthcare Provider Details

I. General information

NPI: 1871925073
Provider Name (Legal Business Name): ANA CASTILLA DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANA CASTILLA
Title or Position: PRESIDENT
Credential:
Phone: 971-275-6188