Magnolia Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MAGNOLIA DENTAL LLC

Practice address

2346 E Brown Rd
Mesa, AZ 85213-5255

Phone

(435) 637-2100

NPI assigned

Oct 1, 2024

Organization subpart

No

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

Authorized official

Name

Marvin Blane Jackson, DDS

Title

Owner

Phone

(435) 637-2100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1727740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1508684267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N FAIRGROUNDS RD STE 1",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014201",
            "telephone_number": "435-637-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2346 E BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852135255",
            "telephone_number": "435-637-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-01",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "BLANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-637-2100",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magellan Health Services of Arizona, Inc.
• Magellan Health Services of Arizona, Inc.
• Magellan Health Services of Arizona, Inc.
• David Anthony Mager, PHARMD
• Sujit Magiyawala, MD
• Magnolia Health & Wellness
• Maguire Consulting LLC
• Nicholas James Maguire, DMD
• Mahafzah PLLC
• Andrea Nicole Mahan, BT

• Dental Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.