MEDICARE: MAGNOLIA ORTHODONTICS OF PETAL, PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1629911698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA ORTHODONTICS OF PETAL, PLLC

Provider Business Mailing Address
First Line	:	35 BEECH LN
Second Line	:
City	:	PETAL
State	:	MS
Zip	:	39465-9457
Country	:	US
Telephone Number	:	601-305-9955
Fax Number	:	601-305-9977

Provider Business Practice Location Address
First Line	:	35 BEECH LN
Second Line	:
City	:	PETAL
State	:	MS
Zip	:	39465-9457
Country	:	US
Telephone Number	:	601-305-9955
Fax Number	:	601-305-9977

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARAH KIMBROUGH
Credential	:	DMD, MDS
Telephone Number	:	601-466-8562

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

Similar Medicare Providers

1710984539 — GERALYNN G. MORRISON M.D.
Practice Location Address:

102 RED MAPLE TRL
PETAL, MS
39465-2678

Practice Phone: 601-310-6455
Practice Fax:

1962494229 — LILLIAN GIBB PT
Practice Location Address:

1227 HWY 42 , SUITE 110
PETAL, MS
39465-2790

Practice Phone: 601-545-2728
Practice Fax: 601-545-2792

1235111311 — BEDFORD CARE CENTER OF PETAL, LLC
Practice Location Address:

908 SOUTH GEORGE STREET
PETAL, MS
39465-2014

Practice Phone: 601-544-7441
Practice Fax: 601-582-3217

1780646943 — ANNA CHRISTINE POWELL ATC, LAT, CSCS
Practice Location Address:

1145 HIGHWAY 42
PETAL, MS
39465-9740

Practice Phone: 601-544-0500
Practice Fax: 601-544-0505

1902861651 — PACIFIC PHYSICIAN SERVICES LLC
Practice Location Address:

425 HIGHWAY 42
PETAL, MS
39465-2891

Practice Phone: 601-584-4890
Practice Fax:

1841247954 — MR. FRED THOMAS HURST JR. CRNA
Practice Location Address:

68 REDFERN TRL
PETAL, MS
39465-9415

Practice Phone: 601-310-6813
Practice Fax:

Directions to “MAGNOLIA ORTHODONTICS OF PETAL, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.