Provider Demographics
NPI:1710549852
Name:MAGNOLIA SMILES OF MAGEE PLLC
Entity Type:Organization
Organization Name:MAGNOLIA SMILES OF MAGEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-735-5086
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-0280
Mailing Address - Country:US
Mailing Address - Phone:601-849-4949
Mailing Address - Fax:
Practice Address - Street 1:1425 SIMPSON HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-4210
Practice Address - Country:US
Practice Address - Phone:601-849-4949
Practice Address - Fax:601-849-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental