Jeny Fernanda Dominguez Castillo

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123565 Issued in GA

Practice address

2900 S Cobb Dr SE
Smyrna, GA 30080-7859

Phone

(470) 282-0051

NPI assigned

Aug 12, 2024

Last updated

Aug 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1629809777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 HASCALL DR SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300644801",
            "telephone_number": "678-467-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 S COBB DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300807859",
            "telephone_number": "470-282-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ CASTILLO",
        "first_name": "JENY",
        "middle_name": "FERNANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-12",
        "last_updated": "2024-08-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• DKW Dentistry
• Phong Hoang DO, M.D.
• Kimberly Shawn Dobson
• Jody R Dodson, APC, CTP, NCC
• Odetta Mary Dodson, LMT
• Kimberly Lynn Domon
• Donald F. Marshall D.D.S. P.C.
• Martha Louise Dorsey, PH.D.
• Nichole Douglass, RN
• Paul Lawrence Douglass, M.D.

• General Practice Dentistry in Smyrna, GA
• Providers in Smyrna, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.