| Magnolia Dental | |
|
10250 Se 167th Place Rd Suite 3 Summerfield FL 34491-8682 | |
| (352) 245-0780 | |
| (352) 347-8369 |
| Full Name | Magnolia Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10250 Se 167th Place Rd, Summerfield, Florida |
| Authorized Official Name and Position | James P Costello (MEMBER) |
| Authorized Official Contact | 3524081400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Dental 10250 Se 167th Place Rd Suite 3 Summerfield FL 34491-8682 Ph: (352) 245-0780 | Magnolia Dental 10250 Se 167th Place Rd Suite 3 Summerfield FL 34491-8682 Ph: (352) 245-0780 |
| NPI Number | 1316119795 |
|---|---|
| Provider Enumeration Date | 03/26/2008 |
| Last Update Date | 03/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316119795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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