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General NPI Number Information
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NPI Number | 1093650418
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Entity Type | Organization
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Legal Business Name | MAGNOLIA FAMILY DENTAL
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 5161 CRAIG RATH BLVD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-6258
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Country | US
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Telephone | 804-744-9051
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Fax | 804-744-9053
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Provider Business Mailing Address
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Address Line | 5161 CRAIG RATH BLVD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-6258
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Country | US
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Telephone | 804-744-9051
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Fax | 804-744-9053
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA SMITH
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Credential | JESSICA SMITH
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Telephone | 804-382-6093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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