MEDICARE: DR. MICHAEL J. MAGINNIS D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	LA2460	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LA2460	OTHER	LA	DENTAL LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	18931	OTHER	LA	STATE DRUG LICENSE #
4	F7198	OTHER	LA	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1184627788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J. MAGINNIS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	7742 OFFICE PARK BLVD
Second Line	:	BLDG A, SUITE 1
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-7601
Country	:	US
Telephone Number	:	225-201-1000
Fax Number	:	225-201-1005

Provider Business Practice Location Address
First Line	:	7742 OFFICE PARK BLVD
Second Line	:	BLDG A, SUITE 1
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-7601
Country	:	US
Telephone Number	:	225-201-1000
Fax Number	:	225-201-1005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/07/2023

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