Healthcare Provider Details

I. General information

NPI: 1992619878
Provider Name (Legal Business Name): MAGNOLIA RIDGE DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 HAMILTON MILL ROAD BLDG 200, SUITE 2200
BUFORD GA
30519
US

IV. Provider business mailing address

3331 HAMILTON MILL ROAD BLDG 200, SUITE 2200
BUFORD GA
30519
US

V. Phone/Fax

Practice location:
  • Phone: 678-541-0770
  • Fax: 678-541-0721
Mailing address:
  • Phone: 678-541-0770
  • Fax: 678-541-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ASIF TAUFIQ
Title or Position: OWNER
Credential: DDS, MBA
Phone: 770-962-0515