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General NPI Number Information
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NPI Number | 1033596812
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Entity Type | Individual
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Provider Name | JACQUELINE CASTER
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 860 TUCK ST STE 200
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City | LEBANON
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State | PA
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Zip | 17042-7477
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Country | US
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Telephone | 717-892-5193
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Fax |
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Provider Business Mailing Address
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Address Line | 860 TUCK ST STE 200
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City | LEBANON
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State | PA
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Zip | 17042-7477
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Country | US
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Telephone | 717-892-5193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.030315
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 64674
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 042095
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License Number State | PA
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