Provider Demographics
NPI:1326078486
Name:MAGNUSON, PRISCILLA KELLEY (DMD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:KELLEY
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1010
Mailing Address - Country:US
Mailing Address - Phone:978-500-2995
Mailing Address - Fax:
Practice Address - Street 1:495 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2515
Practice Address - Country:US
Practice Address - Phone:978-927-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice