Healthcare Provider Details

I. General information

NPI: 1245625342
Provider Name (Legal Business Name): MARIA A MAGURNO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA A MAGURNO PROSTHODONTIST

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 SW 148TH AVE REGENCY SQUARE,
DAVIE FL
33331
US

IV. Provider business mailing address

1436 MEADOWS BLVD
WESTON FL
33327-1805
US

V. Phone/Fax

Practice location:
  • Phone: 954-434-1702
  • Fax:
Mailing address:
  • Phone: 954-235-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20559
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN20559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: