Magic Dental Camden, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02018400 Issued in NJ

Legal business name

MAGIC DENTAL CAMDEN, LLC

Practice address

433 Market St Ste 102
Camden, NJ 08102-1572

Phone

(856) 963-2369

Fax

(856) 963-2369

NPI assigned

Aug 22, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Natalya Kondratyeva, DDSNPI 1316936479

Title

Owner

Phone

(856) 963-0315

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Natalya Kondratyeva, D.D.S.

  • General Practice Dentistry
  • Camden, NJ
  • NPI 1316936479
  NPD Authorized official
• Paul H Kim, DDS

  • Dentist
  • Camden, NJ
  • NPI 1871643064
  NPD (past)

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1235610882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 MARKET ST STE 102",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081021572",
            "telephone_number": "856-963-2369",
            "fax_number": "856-963-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 MARKET ST STE 102",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081021572",
            "telephone_number": "856-963-2369",
            "fax_number": "856-963-2369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Lawrenceville Rd",
            "address_purpose": "LOCATION",
            "city": "Lawrence Township",
            "state": "NJ",
            "postal_code": "086484307",
            "country_code": "US",
            "telephone_number": "609-599-4800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGIC DENTAL CAMDEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-22",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "KONDRATYEVA",
        "authorized_official_first_name": "NATALYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-963-0315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02018400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0617415",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leanne Ard Mader, RN, CRNA
• Nagendra Yadav Madisi, MD
• John James Madison, CRNA
• Rachel Madison
• Paola Alexandra Madrid, CRNA
• Gretchen Magnani, M.D.
• Mohammed Khalid Mahdi, MBCHB
• James Michael Mahon III, CRNA DNP
• Leisha A Mahoney, CNM
• Main Line Medical Supplies

• General Practice Dentistry in Camden, NJ
• Providers in Camden, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; 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.