# MAGNOLIA DENTAL CORPORATION PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164502332
- **Authorized official:** DR. RICHARDS RUDD MILLER DDS (PARTNER)
- **Authorized official phone:** (540) 943-2723

## Contact information

- **Practice address:** 400 SOUTH MAGNOLIA AVENUE, WAYNESBORO, VA 22980
- **Practice address phone:** (540) 943-2723
- **Practice address fax:** (540) 943-1419
- **Mailing address:** 400 SOUTH MAGNOLIA AVENUE, WAYNESBORO, VA 22980
- **Mailing address phone:** (540) 943-2723
- **Mailing address fax:** (540) 943-1419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1354201 | UNITED CONCORDIA | — |
| 01 | — | 201253 | ANTHEM | — |
| 01 | — | 201256 | ANTHEM | — |