NPIMap

Organization Active NPI

Upper Arlington - Bryan Basom DDS LLC

Doing business as Magnolia Dental

  • Dentist
  • Columbus, OH
National Provider Identifier
1013427921
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30.022613 Issued in OH
Legal business name
UPPER ARLINGTON - BRYAN BASOM DDS LLC
Doing business as
Magnolia Dental
Magnolia Dental at Kingsdale
Practice address
1840 Zollinger Rd
Columbus, OH 43221-2850
Phone
(614) 457-3927
Fax
(614) 457-0668
NPI assigned
Oct 5, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bryan Basom, DDS
Title
Owner
Phone
(614) 406-7187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30.022613 OH Primary

Addresses

Primary practice location

1840 Zollinger Rd
Columbus, OH 43221-2850

Mailing address

7870 Olentangy River Rd Ste 205
Columbus, OH 43235-1319
Phone (614) 436-0316

Other names 2

  • Magnolia Dental Doing business as
  • Magnolia Dental at Kingsdale Doing business as

National Provider Directory

National Provider Directory

Locations

1840 Zollinger Rd
Upper Arlington, OH 43221
Phone (614) 442-6754

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1013427921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7870 OLENTANGY RIVER RD STE 205",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432351319",
            "telephone_number": "614-436-0316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 ZOLLINGER RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432212850",
            "telephone_number": "614-457-3927",
            "fax_number": "614-457-0668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER ARLINGTON - BRYAN BASOM DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-05",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "BASOM",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "614-406-7187",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.022613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magnolia Dental at Kingsdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.