Provider Demographics
NPI:1740633353
Name:MAGNOLIA FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:MAGNOLIA FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-455-9057
Mailing Address - Street 1:101 N DOUGLAS BLVD STE T
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3328
Mailing Address - Country:US
Mailing Address - Phone:405-455-9057
Mailing Address - Fax:
Practice Address - Street 1:101 N DOUGLAS BLVD STE T
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3328
Practice Address - Country:US
Practice Address - Phone:405-455-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty