| Magnolia Dental | |
|
1042 Pacific St Ste B San Luis Obispo CA 93401-3661 | |
| (805) 543-6963 | |
| (805) 543-8656 |
| Full Name | Magnolia Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1042 Pacific St Ste B, San Luis Obispo, California |
| Authorized Official Name and Position | Christopher F. Wong (OWNER) |
| Authorized Official Contact | 8055436963 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Dental 1042 Pacific St Ste B San Luis Obispo CA 93401-3661 Ph: (805) 543-6963 | Magnolia Dental 1042 Pacific St Ste B San Luis Obispo CA 93401-3661 Ph: (805) 543-6963 |
| NPI Number | 1225527765 |
|---|---|
| Provider Enumeration Date | 05/09/2018 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225527765 | NPI | - | NPPES |
| NONE | Other | NONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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