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General NPI Number Information
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NPI Number | 1417009150
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Entity Type | Individual
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Provider Name | JOHN ROBERT MAGNACCA DDS
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 900 NW 13TH ST SUITE 202
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City | BOCA RATON
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State | FL
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Zip | 33486-2335
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Country | US
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Telephone | 561-391-6234
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Fax | 561-391-0743
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Provider Business Mailing Address
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Address Line | 900 NW 13TH STREET SUITE 202
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City | BOCA RATON
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State | FL
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Zip | 33486
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Country | US
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Telephone | 561-391-6234
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Fax | 561-391-0743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 06221
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License Number State | FL
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