Provider Demographics
NPI:1326065939
Name:MAGID, MITCHELL J (DMD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:MAGID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1612 GRAVES MILL RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4329
Mailing Address - Country:US
Mailing Address - Phone:701-388-8554
Mailing Address - Fax:701-356-0739
Practice Address - Street 1:1612 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4329
Practice Address - Country:US
Practice Address - Phone:434-316-7111
Practice Address - Fax:434-316-7114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04014127021223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T93005Medicare UPIN