| NPI | 1013427921 |
|---|---|
| Doing Business As | MAGNOLIA DENTAL AT KINGSDALE |
| Doing Business As | MAGNOLIA DENTAL |
| Entity Type | Organization |
| Authorized Contact | BRYAN BASOM Owner 614-406-7187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.022613) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2018-06-16 |