Organization
MAGNOLIA SPRINGS DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW ROBERTO PISCHEK DMD (OWNER)
(251) 213-1101
Entity
Organization
Contact information
Practice address
12440 MAGNOLIA AVE STE 200, MAGNOLIA SPRINGS, AL 36555-6434
(251) 965-1773
Mailing address
12440 MAGNOLIA AVE STE 200, MAGNOLIA SPRINGS, AL 36555-6434
(251) 965-1773
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861985483
GENERAL DENTIST
AL
Enumeration date
09/19/2022
Last updated
09/19/2022
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