Organization
MAGNOLIA DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BLANE JACKSON DDS (OWNER)
(435) 637-2100
Entity
Organization
Contact information
Practice address
2346 E BROWN RD, MESA, AZ 85213-5255
(435) 637-2100
Mailing address
250 N FAIRGROUNDS RD STE 1, PRICE, UT 84501-4201
(435) 637-2100
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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