| NPI | 1467977090 |
|---|---|
| Doing Business As | MAGNOLIA DENTAL |
| Entity Type | Organization |
| Authorized Contact | CARMEN ELIZABETH JOHNSON Owner 765-631-6934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2022-07-21 |