Provider Demographics
NPI:1982754545
Name:EGEMEN, MAGNOLIA (DENTAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:
Last Name:EGEMEN
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MACARTHUR CSWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5101
Mailing Address - Country:US
Mailing Address - Phone:305-535-4535
Mailing Address - Fax:305-535-4351
Practice Address - Street 1:100 MACARTHUR CSWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33139-5101
Practice Address - Country:US
Practice Address - Phone:305-535-4535
Practice Address - Fax:305-535-4351
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant