Healthcare Provider Details

I. General information

NPI: 1154225860
Provider Name (Legal Business Name): MAGNOLIA FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 NW 37TH PL STE A
GAINESVILLE FL
32606-8147
US

IV. Provider business mailing address

4121 NW 37TH PL STE A
GAINESVILLE FL
32606-8147
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-7361
  • Fax: 352-373-7150
Mailing address:
  • Phone: 352-373-7361
  • Fax: 352-373-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEANN SMITH
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 352-373-7361