Provider Demographics
NPI:1205229101
Name:MAGNOLIA SMILES FAMILY DENTISTRY,PLLC
Entity Type:Organization
Organization Name:MAGNOLIA SMILES FAMILY DENTISTRY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-735-5086
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:806 MISSISSIPPI DR
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-0368
Mailing Address - Country:US
Mailing Address - Phone:601-735-5086
Mailing Address - Fax:601-735-5089
Practice Address - Street 1:806 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2438
Practice Address - Country:US
Practice Address - Phone:601-735-5086
Practice Address - Fax:601-735-5086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSCAR R JONES DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3744-141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty