Provider Demographics
NPI:1285512343
Name:MAGNOLIA DENTISTRY, LLC
Entity type:Organization
Organization Name:MAGNOLIA DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOA
Authorized Official - Middle Name:THI-THANH
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-388-9971
Mailing Address - Street 1:852 KINGSWAY DR W
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3022
Mailing Address - Country:US
Mailing Address - Phone:504-388-9771
Mailing Address - Fax:
Practice Address - Street 1:1219 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3771
Practice Address - Country:US
Practice Address - Phone:504-340-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental