Krishna M Gopisetty D.D.S., M.S., P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

019029636 Issued in IL

Legal business name

KRISHNA M GOPISETTY D.D.S., M.S., P.C.

Practice address

1738 W North Ave
Chicago, IL 60622-2147

Phone

(773) 276-5566

NPI assigned

Dec 21, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Krishna M Gopisetty, D.D.S., M.S.

Title

President

Phone

(773) 276-5566

Specialties & licenses 1

Addresses

Other names 1

• Wicker Park Dental Group Doing business as

Locations

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

{
    "created_epoch": "1419120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419120000000",
    "number": "1356749550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1738 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222147",
            "telephone_number": "773-276-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222147",
            "telephone_number": "773-276-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISHNA M GOPISETTY D.D.S., M.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-21",
        "last_updated": "2014-12-21",
        "status": "A",
        "authorized_official_last_name": "GOPISETTY",
        "authorized_official_first_name": "KRISHNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-276-5566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wicker Park Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kris G McGrath MD SC
• Jeneane Krischak
• Michelle Krischel, M.S., PA-C, ATC,
• Kevin Matthew Krise, PA-C
• Sai Ramani Krishna Kumar
• Pallavi Sai Krishna Rao, MD
• Phari Krishna, M.D
• Ashwini Krishnakumar
• Venkatesan Krishnamoorthi
• Aswin Krishnamoorthy, M.D.

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2014; 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.