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General NPI Number Information
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NPI Number | 1700677416
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SMILES OF PURVIS, PLLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 101 SHELBY SPEIGHTS DR
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City | PURVIS
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State | MS
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Zip | 39475-4094
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Country | US
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Telephone | 601-735-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 806 MISSISSIPPI DR
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City | WAYNESBORO
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State | MS
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Zip | 39367-2438
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Country | US
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Telephone | 601-735-5086
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Fax |
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Authorized Official
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Title or Position | DENTIST/PARTNER
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Name | DR. OSCAR RANDOLPH JONES
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Credential | DMD
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Telephone | 601-410-8262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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