# MAGNOLIA DENTAL

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

## Provider details

- **NPI number:** 1699277228
- **Authorized official:** DR. GERARD THOMAS MACY DDS (DENTIST)
- **Authorized official phone:** (903) 603-4406

## Contact information

- **Practice address:** 507 N 3RD ST, MABANK, TX 75147-8328
- **Practice address phone:** (903) 603-4406
- **Practice address fax:** (903) 201-6787
- **Mailing address:** 507 N 3RD ST, MABANK, TX 75147-8328
- **Mailing address phone:** (903) 603-4406
- **Mailing address fax:** (903) 201-6787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 22174 | TX | Yes |

## Other

- **Enumeration date:** 02/28/2018
- **Last updated:** 02/28/2018