Provider Demographics
NPI:1487795472
Name:GARCIA CASTELLANOS, JACQUELINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:GARCIA CASTELLANOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 SW 128TH CT STE 103
Mailing Address - Street 2:KENDALLWOOD OFFICE PARK II
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4665
Mailing Address - Country:US
Mailing Address - Phone:305-279-6400
Mailing Address - Fax:305-403-8704
Practice Address - Street 1:12001 SW 128TH CT STE 103
Practice Address - Street 2:KENDALLWOOD OFFICE PARK II
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4665
Practice Address - Country:US
Practice Address - Phone:305-279-6400
Practice Address - Fax:305-403-8704
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice