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General NPI Number Information
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NPI Number | 1174422869
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Entity Type | Organization
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Legal Business Name | MAGNOLIA DENTAL PLLC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 192 MAIN ST OP4
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City | ELLSWORTH
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State | ME
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Zip | 04605-1976
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Country | US
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Telephone | 425-246-5305
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Fax |
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Provider Business Mailing Address
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Address Line | 17 WATER ST
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City | MILBRIDGE
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State | ME
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Zip | 04658-3217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | NIKOLE NOVIKOVA
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Credential | DMD, MPH
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Telephone | 415-246-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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