NPIMap

Organization Active NPI

Magnolia Dental

  • General Practice Dentistry
  • Chillicothe, OH
National Provider Identifier
1104134881
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30022613 Issued in OH
Legal business name
MAGNOLIA DENTAL
Practice address
11 Medical Dr
Chillicothe, OH 45601-8603
Phone
(740) 775-8050
Fax
(740) 775-8053
NPI assigned
Sep 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

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

Authorized official

Name
Dr. Bryan D Basom, DDSNPI 1043499650
Title
Owner/Dentist
Phone
(740) 775-8050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30022613 OH Primary

Addresses

Primary practice location

11 Medical Dr
Chillicothe, OH 45601-8603

Mailing address

11 Medical Dr
Chillicothe, OH 45601-8603
Phone (740) 775-8050

National Provider Directory

National Provider Directory

Locations

11 Medical Dr
Chillicothe, OH 45601
Phone (740) 775-8050

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1104134881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MEDICAL DR",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456018603",
            "telephone_number": "740-775-8050",
            "fax_number": "740-775-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MEDICAL DR",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456018603",
            "telephone_number": "740-775-8050",
            "fax_number": "740-775-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "BASOM",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "740-775-8050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30022613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chillicothe, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.