Nisha Sundaragopal, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27303 Issued in TX

Practice address

5300 San Dario Ave
#C2
Laredo, TX 78041-3000

Phone

(956) 723-6568

NPI assigned

Aug 3, 2011

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 names 1

• Dr. Nisha Sundaragopal Other name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lexington Dental Group

  • General Practice Dentistry
  • Houston, TX
  • NPI 1750547659
  NPD (past)

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456444800000",
    "number": "1295013514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11767 KATY FWY",
            "address_2": "STE 505",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770791768",
            "telephone_number": "281-679-9340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 SAN DARIO AVE",
            "address_2": "#C2",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780413000",
            "telephone_number": "956-723-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARAGOPAL",
        "first_name": "NISHA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2016-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "27303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NISHA",
            "last_name": "SUNDARAGOPAL",
            "prefix": "DR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pediatric Dentistry in Laredo, TX
• Providers in Laredo, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.