Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 019.030315 | IL |
Y | 1223P0221X | Pediatric Dentist | 042095 | PA |
N | 1223P0221X | Pediatric Dentist | 64674 | CA |
NPI | 1033596812 |
---|---|
Provider Name | Jacqueline Caster |
First Address | Camp Hill, PA 17011-4049 |
Second Address | Camp Hill, PA 17011-4049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2015 |
Last Update Date | 07/09/2021 |