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NPI Code Detail

MEDICARE: MAGNOLIA DENTAL

MEDICARE: MAGNOLIA DENTAL
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
1122300000XDentistDN0012295FL

General Provider Information

NPI Number : 1558536706
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNOLIA DENTAL
Provider Business Mailing Address
First Line : 9625 WESTVIEW DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-2513
Country : US
Telephone Number : 954-227-1417
Fax Number : 954-227-0197
Provider Business Practice Location Address
First Line : 9625 WESTVIEW DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-2513
Country : US
Telephone Number : 954-227-1417
Fax Number : 954-227-0197
Authorized Official
Title or Position : DR
Name : DR. RALPH C COLLAZO
Credential : DDS
Telephone Number : 954-227-1417
Provider Enumeration Date : 04/29/2008
Last Update Date : 04/29/2008

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Directions to “MAGNOLIA DENTAL ” Practice Location

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