Provider Demographics
NPI:1235291873
Name:MILTON A. MAGOS D.M.D.,P.A.
Entity Type:Organization
Organization Name:MILTON A. MAGOS D.M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-384-5543
Mailing Address - Street 1:1151 CASSAT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6467
Mailing Address - Country:US
Mailing Address - Phone:904-384-5543
Mailing Address - Fax:
Practice Address - Street 1:1151 CASSAT AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6467
Practice Address - Country:US
Practice Address - Phone:904-384-5543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN52141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty