Conrad Magno, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5906-15 Issued in WI

Practice address

1220 W Ogden Ave
Suite a
Naperville, IL 60563-8969

Phone

(630) 848-1212

Fax

(630) 848-1254

NPI assigned

Oct 9, 2007

Last updated

Jun 6, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chicago Dental Spa, LTD.

  dba Distinctive Dentistry

  • General Practice Dentistry
  • Oak Park, IL
  • NPI 1851529382
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1215125935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3054 ACKER ST",
            "city": "CROSS PLAINS",
            "state": "WI",
            "postal_code": "535289557",
            "telephone_number": "312-545-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 W OGDEN AVE",
            "address_2": "SUITE A",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638969",
            "telephone_number": "630-848-1212",
            "fax_number": "630-848-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGNO",
        "first_name": "CONRAD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2024-06-06",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5906-15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851529832",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Ranae Madura, M.A., CF-SLP
• Mariam Mafee, M.D.
• Maidy Magadan
• Robert O Maganini, MD
• Kambiz Tony Maghsoudi, D.C.
• Christena Elizabeth Magyk-Bey
• Maha Behavioral Health Services LLC
• Margot Gay Mahan, PSY.D.
• Thomas A Mahan, PHD
• Denise Mahasi

• General Practice Dentistry in Naperville, IL
• Providers in Naperville, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.