Provider Demographics
NPI:1508564246
Name:MAG DMD PC
Entity Type:Organization
Organization Name:MAG DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-935-3610
Mailing Address - Street 1:1000 BROOKTREE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9286
Mailing Address - Country:US
Mailing Address - Phone:724-935-3610
Mailing Address - Fax:
Practice Address - Street 1:1000 BROOKTREE RD STE 101
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9286
Practice Address - Country:US
Practice Address - Phone:724-935-3610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental