Provider Demographics
NPI:1225762479
Name:GENESIS DENTAL, PLLC
Entity Type:Organization
Organization Name:GENESIS DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-481-7572
Mailing Address - Street 1:6688 NOLENSVILLE RD STE 108-125
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8833
Mailing Address - Country:US
Mailing Address - Phone:931-304-8447
Mailing Address - Fax:
Practice Address - Street 1:24 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3362
Practice Address - Country:US
Practice Address - Phone:931-304-8447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental