Magnolia Dental, LLC
Dentist, General Practice in Mitchellville, MD. Organization (NPI-2).
NPI number1043797152
StatusActive
Last updated in NPPESJun 17, 2019
Details
- NPI
- 1043797152
- Entity type
- Organization (NPI-2)
- Legal business name
- Magnolia Dental, LLC
- Organization subpart
- No
- Enumeration date
- Jul 21, 2018
- Last updated
- Jun 17, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
10208 Lake Arbor WayMitchellville, MD 20721
Phone 301-485-5463
Mailing address
10208 Lake Arbor WayMitchellville, MD 20721-3113
Phone 301-485-5463
Authorized official
Dawn L Tyler
Dentist
3014855463
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