Healthcare Provider Details

I. General information

NPI: 1457274987
Provider Name (Legal Business Name): HAVEN DENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE PH L
SOUTH MIAMI FL
33143-4721
US

IV. Provider business mailing address

7000 SW 62ND AVE PH L
SOUTH MIAMI FL
33143-4721
US

V. Phone/Fax

Practice location:
  • Phone: 305-330-4142
  • Fax:
Mailing address:
  • Phone: 305-330-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JESSICA MUSTELIER
Title or Position: PRESIDENT
Credential: DMD
Phone: 305-407-7779