Provider Demographics
NPI:1861650079
Name:GERARD R. MAGNO, D.D.S., P.A.
Entity Type:Organization
Organization Name:GERARD R. MAGNO, D.D.S., P.A.
Other - Org Name:WAKEFIELD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-570-8338
Mailing Address - Street 1:2800 WAKEFIELD PINES DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8998
Mailing Address - Country:US
Mailing Address - Phone:919-570-8338
Mailing Address - Fax:
Practice Address - Street 1:2800 WAKEFIELD PINES DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8998
Practice Address - Country:US
Practice Address - Phone:919-570-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental