Provider Demographics
NPI:1184627788
Name:MAGINNIS, MICHAEL J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MAGINNIS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7742 OFFICE PARK BLVD
Mailing Address - Street 2:BLDG A, SUITE 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7601
Mailing Address - Country:US
Mailing Address - Phone:225-201-1000
Mailing Address - Fax:225-201-1005
Practice Address - Street 1:7742 OFFICE PARK BLVD
Practice Address - Street 2:BLDG A, SUITE 1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7601
Practice Address - Country:US
Practice Address - Phone:225-201-1000
Practice Address - Fax:225-201-1005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA24601223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALA2460OtherDENTAL LICENSE #
LA1824607Medicaid
LA18931OtherSTATE DRUG LICENSE #
LAF7198OtherBC/BS PROVIDER #
LAF7198OtherBC/BS PROVIDER #
LAF7198OtherBC/BS PROVIDER #
LA1824607Medicaid