Provider Demographics
NPI:1467654145
Name:MAGNUSON, DONALD WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:MAGNUSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-0310
Mailing Address - Country:US
Mailing Address - Phone:530-432-1187
Mailing Address - Fax:530-432-2574
Practice Address - Street 1:17420 PENN VALLEY DR
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-8945
Practice Address - Country:US
Practice Address - Phone:530-432-1187
Practice Address - Fax:530-432-2574
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist