NPI | 1558768978 |
---|---|
Doing Business As | MAGNOLIA FAMILY DENTISTRY |
Entity Type | Organization |
Authorized Contact | KENDRA WALKER Credentialing Supervisor 217-540-8312 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2014-12-01 |
Last Update Date | 2021-10-14 |