Healthcare Provider Details

I. General information

NPI: 1184627788
Provider Name (Legal Business Name): MICHAEL J. MAGINNIS D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7742 OFFICE PARK BLVD BLDG A, SUITE 1
BATON ROUGE LA
70809-7601
US

IV. Provider business mailing address

7742 OFFICE PARK BLVD BLDG A, SUITE 1
BATON ROUGE LA
70809-7601
US

V. Phone/Fax

Practice location:
  • Phone: 225-201-1000
  • Fax: 225-201-1005
Mailing address:
  • Phone: 225-201-1000
  • Fax: 225-201-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberLA2460
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: