Provider Demographics
NPI:1841990330
Name:MAGNOLIA DENTISTRY, PLLC
Entity type:Organization
Organization Name:MAGNOLIA DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZANIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOLHASANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-422-0808
Mailing Address - Street 1:3500 SHADOW RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072
Mailing Address - Country:US
Mailing Address - Phone:469-422-0808
Mailing Address - Fax:
Practice Address - Street 1:1922 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7100
Practice Address - Country:US
Practice Address - Phone:972-414-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty