NPIMap

Organization Active NPI

Lidia Marisela Marcinkowski DDS Inc

Doing business as Magnolia Dental Group

  • Dentist
  • Corona, CA
National Provider Identifier
1558759845
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
47125 Issued in CA
Legal business name
LIDIA MARISELA MARCINKOWSKI DDS INC
Doing business as
Magnolia Dental Group
Practice address
13100 Magnolia Ave
Suite B
Corona, CA 92879-5365
Phone
(951) 278-8426
Fax
(951) 278-8427
NPI assigned
Jan 8, 2015
Last updated
Jan 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Authorized official

Name
Lidia Marisela Marcinkowski, DDSNPI 1972561603
Title
President
Phone
(951) 278-8426

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 47125 CA Primary

Addresses

Primary practice location

13100 Magnolia Ave
Suite B
Corona, CA 92879-5365

Mailing address

13100 Magnolia Ave
Suite B
Corona, CA 92879-5365
Phone (951) 278-8426

Other names 1

  • Magnolia Dental Group Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1420675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420675200000",
    "number": "1558759845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13100 MAGNOLIA AVE",
            "address_2": "SUITE B",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928795365",
            "telephone_number": "951-278-8426",
            "fax_number": "951-278-8427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13100 MAGNOLIA AVE",
            "address_2": "SUITE B",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928795365",
            "telephone_number": "951-278-8426",
            "fax_number": "951-278-8427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIDIA MARISELA MARCINKOWSKI DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "MARCINKOWSKI",
        "authorized_official_first_name": "LIDIA",
        "authorized_official_middle_name": "MARISELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-278-8426",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "47125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; 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.