Healthcare Provider Details

I. General information

NPI: 1669600789
Provider Name (Legal Business Name): JOCELYN PADILLA MAGAHIS DDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9877
  • Fax:
Mailing address:
  • Phone: 718-226-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number055090-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: