Healthcare Provider Details

I. General information

NPI: 1508564246
Provider Name (Legal Business Name): MAG DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROOKTREE RD STE 101
WEXFORD PA
15090-9286
US

IV. Provider business mailing address

1000 BROOKTREE RD STE 101
WEXFORD PA
15090-9286
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-3610
  • Fax:
Mailing address:
  • Phone: 724-935-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL GUTHRIE
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 724-935-3610