Jordan Antonisse Castillo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2017000011 Issued in MO

Practice address

8200 Dodge St
Omaha, NE 68114-4113

Phone

(402) 552-7267

NPI assigned

Jun 25, 2015

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alex Sharifian DDS Parkville Modern Dentistry, PC

  • Dentist
  • Kansas City, MO
  • NPI 1275970279
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1104208172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4508 NE 85TH ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641567802",
            "telephone_number": "214-535-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 DODGE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144113",
            "telephone_number": "402-552-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTILLO",
        "first_name": "JORDAN",
        "middle_name": "ANTONISSE",
        "name_prefix": "Mrs.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-25",
        "last_updated": "2022-07-21",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2017000011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthuan Castillo Cuellar
• Abigail Castillo
• Alejandra Castillo
• Anna Castillo
• Belen Castillo
• Lauren Castillo
• Shana Lea Castillo, PHARMD
• Teresa Castillo
• Carly Castle
• Anthony William Castleberry, M.D.

• All providers in Omaha, NE
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.