Provider Demographics
NPI:1609118421
Name:CASTELLONE, JO-ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JO-ANN
Middle Name:
Last Name:CASTELLONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 ALBANY TPKE
Mailing Address - Street 2:PO BOX 456
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2554
Mailing Address - Country:US
Mailing Address - Phone:860-693-0887
Mailing Address - Fax:860-693-1079
Practice Address - Street 1:191 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2554
Practice Address - Country:US
Practice Address - Phone:860-693-8314
Practice Address - Fax:860-693-1079
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8384122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice