NPIMap

Organization Active NPI

Magnolia Green Dental Care, P.a.

  • Dentist
  • Lakewood Ranch, FL
National Provider Identifier
1316671688
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MAGNOLIA GREEN DENTAL CARE, P.A.
Practice address
6975 Professional Pkwy Ste B
Lakewood Ranch, FL 34240-8430
Phone
(941) 240-2750
Fax
(863) 808-0589
NPI assigned
Jul 13, 2022
Last updated
Jul 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Kevin KrauseNPI 1760641609
Title
President
Phone
(941) 923-3802

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6975 Professional Pkwy Ste B
Lakewood Ranch, FL 34240-8430

Mailing address

1 N Dale Mabry Hwy Ste 605
Tampa, FL 33609-2781
Phone (813) 692-2224

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1316671688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N DALE MABRY HWY STE 605",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092781",
            "telephone_number": "813-692-2224",
            "fax_number": "813-200-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6975 PROFESSIONAL PKWY STE B",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342408430",
            "telephone_number": "941-240-2750",
            "fax_number": "863-808-0589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA GREEN DENTAL CARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "KRAUSE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-923-3802"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood Ranch, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.