Provider Demographics
NPI:1558856062
Name:MAGNO, EVANGELINE (DMD)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:MAGNO
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 1:1525 ELECTION HOUSE RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9059
Mailing Address - Country:US
Mailing Address - Phone:740-653-1031
Mailing Address - Fax:740-653-4895
Practice Address - Street 1:1525 ELECTION HOUSE RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9059
Practice Address - Country:US
Practice Address - Phone:740-653-1031
Practice Address - Fax:740-653-4895
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist