Healthcare Provider Details

I. General information

NPI: 1407552888
Provider Name (Legal Business Name): JASMINE GONZALEZ CASTILLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 NW N RVR DR
MIAMI FL
33125-2892
US

IV. Provider business mailing address

1440 NW NORTH RIVER DR
MIAMI FL
33125-2892
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-9887
  • Fax:
Mailing address:
  • Phone: 786-419-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN28097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: