Provider Demographics
NPI:1437346376
Name:MAGAZINE, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MAGAZINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LONG LAKE
Mailing Address - Street 2:STE 311 CREST EXPRESSIONS DENTAL CENTERS
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-203-1119
Mailing Address - Fax:248-723-0052
Practice Address - Street 1:5002 73RD AVE N
Practice Address - Street 2:APPLE DENTAL AFFILIATES PA
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-544-7733
Practice Address - Fax:727-544-3150
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist