Provider Demographics
NPI:1386032951
Name:MAGNOLIA DENTAL CARE PC
Entity Type:Organization
Organization Name:MAGNOLIA DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NILSSON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-666-8904
Mailing Address - Street 1:720 OAK CIRCLE DR W STE 400
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-4252
Mailing Address - Country:US
Mailing Address - Phone:251-666-8904
Mailing Address - Fax:251-666-8905
Practice Address - Street 1:720 OAK CIRCLE DR W STE 400
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4252
Practice Address - Country:US
Practice Address - Phone:251-666-8904
Practice Address - Fax:251-666-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5434261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental