Magnolia Dental

NPI #1104134881 in Chillicothe, Ohio

Provider Information

NPI Number: 1104134881
Entity Type: Organization
Organization Name: Magnolia Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 16, 2010
Last Updated: Sep 16, 2010

Practice Location

Address: 11 MEDICAL DR
City: Chillicothe
State: Ohio
ZIP Code: 45601-8603
Phone: (740) 775-8050

Authorized Official

Name: DR. BRYAN D BASOM, DDS
Title: OWNER/DENTIST
Phone: (740) 775-8050

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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