Magnolia M Pelaez, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01796300 Issued in NJ

Practice address

1301 Atlantic Ave
Atlantic City, NJ 08401-7247

Phone

(609) 572-0000

Fax

(609) 567-0039

NPI assigned

Apr 11, 2006

Sex

Female

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

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1245293984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 S WHITE HORSE PIKE",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080372018",
            "telephone_number": "609-567-0200",
            "fax_number": "609-704-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 ATLANTIC AVE",
            "city": "ATLANTIC CITY",
            "state": "NJ",
            "postal_code": "084017247",
            "telephone_number": "609-572-0000",
            "fax_number": "609-567-0039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELAEZ",
        "first_name": "MAGNOLIA",
        "middle_name": "M",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01796300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0120278",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tejalkumar Patel, NP
• Urmil Patel
• Yesha Nitang Patel
• PCR Health Center
• Raymond Pearson
• John Thomas Pericles, D.O.
• Peter Thompson, M.D., LLC
• Jeanmarie Petersen, DO
• Casey Alicia Peterson, NP-C
• Hemanth K Reddy Pethari, MD

• General Practice Dentistry in Atlantic City, NJ
• Providers in Atlantic City, 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 Jul 11, 2007; 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.