| NPI | 1598545386 |
|---|---|
| Doing Business As | SOUTHERN MAGNOLIA DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | AKEELE JOHNSON-VALLOT Owner 318-229-3121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2023-10-02 |