Organization
MAGNOLIA FAMILY DENTISTRY OF COLUMBUS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNIE J. RICHARDSON JR. DMD (OWNER/CEO)
(662) 328-8001
Entity
Organization
Contact information
Practice address
2401 5TH ST N STE 2, COLUMBUS, MS 39705-2005
(662) 328-8001
(888) 852-8644
Mailing address
2401 5TH ST N STE 2, COLUMBUS, MS 39705-2005
(662) 328-8001
(888) 852-8644
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1860-79
MS
1223G0001X
General Practice Dentistry
3160-00
MS
1223G0001X
General Practice Dentistry
Primary
3463-08
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02150825
—
MS
Enumeration date
03/10/2010
Last updated
03/10/2010
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