Provider Demographics
NPI:1043458490
Name:MAGICLAND DENTAL
Entity type:Organization
Organization Name:MAGICLAND DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUANOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:DA
Authorized Official - Phone:310-329-8241
Mailing Address - Street 1:3820 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2408
Mailing Address - Country:US
Mailing Address - Phone:310-792-5200
Mailing Address - Fax:
Practice Address - Street 1:3820 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2408
Practice Address - Country:US
Practice Address - Phone:310-792-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44907333140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric