Provider Demographics
NPI:1831983576
Name:CASTEDO, JOHNNA LEE (DDS)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:LEE
Last Name:CASTEDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JOHNNA
Other - Middle Name:LEE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:875 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3513
Mailing Address - Country:US
Mailing Address - Phone:901-448-6210
Mailing Address - Fax:
Practice Address - Street 1:875 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3513
Practice Address - Country:US
Practice Address - Phone:901-448-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014749A122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist