Magnolia Pedraza, D.M.D., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021.001709 019.02272 Issued in IL

Practice address

241 W Weaver Rd
Suite 220
Forsyth, IL 62535-9762

Phone

(217) 876-0547

Fax

(217) 876-0601

NPI assigned

Nov 15, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689746281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 W WEAVER RD",
            "address_2": "SUITE 220",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625359762",
            "telephone_number": "217-876-0547",
            "fax_number": "217-876-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 W WEAVER RD",
            "address_2": "SUITE 220",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625359762",
            "telephone_number": "217-876-0547",
            "fax_number": "217-876-0601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDRAZA",
        "first_name": "MAGNOLIA",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021.001709 019.02272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney L Moutray, RD LDN CDE
• Erin E Noblitt, NP
• Oneopto Il 2 PLLC
• Roberto Pabalate, MD
• Priscilla A Pappas-Walker, OD
• Marilee Dalton Peters, N.P.
• Ashley Phillips, PT, DPT
• Jane Piraino, N.P.
• Hannah Alyce Prater, FNP-C
• Maryam Qureshi, M.D.

• Periodontics in Forsyth, IL
• Providers in Forsyth, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.