Mid Ohio Dental Associates

Primary specialty

DentistTaxonomy code 122300000X

License

30016727 Issued in OH

Legal business name

MID OHIO DENTAL ASSOCIATES

Practice address

3079 W. Broad Ste Suite 7
Columbus, OH 43204

Phone

(614) 279-9204

Fax

(614) 279-9208

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Daniel Castilla, DDS

Title

Dentist

Phone

(614) 279-9204

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mid Ohio Dental Associates Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1619086717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3079 W. BROAD STE SUITE 7",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43204",
            "telephone_number": "614-279-9204",
            "fax_number": "614-279-9208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3079 W. BROAD STE SUITE 7",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43204",
            "telephone_number": "614-279-9204",
            "fax_number": "614-279-9208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID OHIO DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-09-02",
        "status": "A",
        "authorized_official_last_name": "CASTILLA",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "614-279-9204",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30016727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2210039",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTH",
            "identifier": "9180566",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Ohio Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaitlynn Jane Mickey
• Jon Mickle, NP
• Toiyuan Mickles
• Angela Mickley, RN
• Haley Micsak, M.A., CF-SLP
• Mid Ohio Dermatology
• Mid Ohio Eye Outpatient Surgery Center
• Mid Ohio Home Health Co LLC
• Mid Ohio Medical Transport
• Mid Ohio Neurological Services Inc

• All providers in Columbus, OH
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.