Healthcare Provider Details

I. General information

NPI: 1841947298
Provider Name (Legal Business Name): JASMINE MAGBUTAY PASCO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE MINA MAGBUTAY

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number83143
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD14765
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: