Organization
MAGNOLIA GREEN DENTAL CARE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN KRAUSE (PRESIDENT)
(941) 923-3802
Entity
Organization
Contact information
Practice address
6975 PROFESSIONAL PKWY STE B, LAKEWOOD RANCH, FL 34240-8430
(941) 240-2750
(863) 808-0589
Mailing address
1 N DALE MABRY HWY STE 605, TAMPA, FL 33609-2781
(813) 692-2224
(813) 200-3400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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