MEDICARE: JESSICA CASTILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.036991	IL

General Provider Information

NPI Number	:	1043913171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CASTILLO

Provider Business Mailing Address
First Line	:	801 S PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-7210
Country	:	US
Telephone Number	:	312-996-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 OGDEN AVE STE 104
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7542
Country	:	US
Telephone Number	:	630-585-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	05/27/2026

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Directions to “ JESSICA CASTILLO ” Practice Location

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