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SOUTHERN MAGNOLIA DENTISTRY
NPI 1598545386
Dentist - Pediatric Dentistry in Alexandria, LA

Active since September 29, 2023
3215 MASONIC DR, ALEXANDRIA, LA 71301(318) 229-3121 Get Directions Write a Review

NPPES record last updated: October 2, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Southern Magnolia Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN MAGNOLIA DENTISTRY (NPI 1598545386) is a healthcare organization registered as a pediatric dentistry in Alexandria, Louisiana and active in the NPI registry since September 2023. The organization lists Akeele Johnson-vallot, Owner, as its authorized official.

NPPES Registry Identity

NPI1598545386
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameSOUTHERN MAGNOLIA DENTISTRY, LLC
Location Address3215 MASONIC DRAlexandria, LA 71301-4246
Mailing Address3215 Masonic DrAlexandria, LA 71301-4246 · (318) 229-3121
Phone(318) 229-3121
Organization SubpartNo
Authorized OfficialAkeele Johnson-vallotOwner · (318) 229-3121
Enumeration DateSeptember 29, 2023
Last NPPES UpdateOctober 2, 2023
NPPES CertifiedOctober 2, 2023
✔ NPI 1598545386 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
3215 MASONIC DR, Alexandria, LA 71301
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Other Names 1

Doing Business AsSouthern Magnolia Dentistry

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southern Magnolia Dentistry is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southern Magnolia Dentistry, which bills Medicare for the services this clinician delivers.

Clinician (1)

Akeele Johnson-Vallot, DDS, MSD
Pediatric Dentistry
NPI 1144574450
3215 MASONIC DR
Alexandria, LA 71301
(318) 542-4005
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Magnolia Dentistry, LLC's NPI number?

The NPI number for Southern Magnolia Dentistry, LLC is 1598545386. It was assigned to this organization in the NPPES registry on September 29, 2023. The provider is doing business as Southern Magnolia Dentistry.

Where is Southern Magnolia Dentistry, LLC located?

Southern Magnolia Dentistry, LLC is located at 3215 Masonic Dr, Alexandria, LA 71301. The listed phone number is (318) 229-3121.

What is Southern Magnolia Dentistry, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Southern Magnolia Dentistry, LLC enrolled in Medicare?

Yes. Southern Magnolia Dentistry, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Magnolia Dentistry, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Pediatric Dentistry) reassigns their Medicare billing to Southern Magnolia Dentistry, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southern Magnolia Dentistry, LLC was last updated on October 2, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.