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General NPI Number Information
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NPI Number | 1194328914
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Entity Type | Organization
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Legal Business Name | MAGNOLIA DENTAL CARE, PLLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S STE 270
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City | EDINA
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State | MN
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Zip | 55435-2119
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Country | US
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Telephone | 952-927-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N 2ND ST UNIT 410
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City | MINNEAPOLIS
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State | MN
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Zip | 55401-1587
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Country | US
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Telephone | 763-242-6618
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARAH LATTERELL
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Credential | DDS
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Telephone | 763-242-6618
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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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