Organization
MAGNOLIA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN D BASOM DDS (OWNER/DENTIST)
(740) 775-8050
Entity
Organization
Contact information
Practice address
11 MEDICAL DR, CHILLICOTHE, OH 45601-8603
(740) 775-8050
(740) 775-8053
Mailing address
11 MEDICAL DR, CHILLICOTHE, OH 45601-8603
(740) 775-8050
(740) 775-8053
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30022613
OH
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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