Southern Magnolia Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SOUTHERN MAGNOLIA DENTISTRY, LLC

Practice address

3215 Masonic Dr
Alexandria, LA 71301-4246

Phone

(318) 229-3121

NPI assigned

Sep 29, 2023

Organization subpart

No

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

Authorized official

Name

Akeele Johnson-VallotNPI 1144574450

Title

Owner

Phone

(318) 229-3121

Specialties & licenses 1

Addresses

Other names 1

• Southern Magnolia Dentistry Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

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

• Akeele Ayanna Johnson-Vallot, DDS, MSD

  • Pediatric Dentistry
  • Alexandria, LA
  • NPI 1144574450
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1598545386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 MASONIC DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713014246",
            "telephone_number": "318-229-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 MASONIC DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713014246",
            "telephone_number": "318-229-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAGNOLIA DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-VALLOT",
        "authorized_official_first_name": "AKEELE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-229-3121"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Magnolia Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Magnolia Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fiorella Sonia Sotomayor Villanueva, MD
• Khaldoun Soudan, MD
• Southern Emergency Consultants, LLC
• Southern Home Care Services, Inc
• Southern Inpatient Specialists, LLC
• Southern Medical Staffing, LLC
• Southern Pediatric Clinic
• Southern Sprouts Pediatrics, LLC
• Jasmine Sparks
• Speak Center of Louisiana

• Pediatric Dentistry in Alexandria, LA
• Providers in Alexandria, LA by specialty
• Pediatric Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.