Active NPI
Aishwarya Indiramohan, DDS
- Pediatric Dentistry
- Springfield, IL
National Provider Identifier
1881949592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 31773
- Practice address
- 802 N 9TH St
Springfield, IL 62702-6309 - Phone
- (888) 988-4066
- Fax
- (847) 496-7603
- NPI assigned
- Jul 18, 2012
- Last updated
- Jun 9, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.029137 | IL | |
| Pediatric Dentistry | 1223P0221X | 31773 | TX | Primary |
Addresses
Primary practice location
802 N 9TH St
Springfield, IL 62702-6309
Mailing address
5700 Edwards Ranch Rd Ste 100
Fort Worth, TX 76109-4128
Phone (817) 292-2004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029137 | IL | MD | Dentist |
| 31773 | TX | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preece Church and Associates, Pediatric Dentistry | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Fort Worth, TX
- NPI 1043754740
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623196800000",
"number": "1881949592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 EDWARDS RANCH RD STE 100",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761094128",
"telephone_number": "817-292-2004",
"fax_number": "178-292-7083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 N 9TH ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627026309",
"telephone_number": "888-988-4066",
"fax_number": "847-496-7603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDIRAMOHAN",
"first_name": "AISHWARYA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-18",
"last_updated": "2021-06-09",
"certification_date": "2021-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.029137",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "31773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
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- Mastan Rao Indlamuri, M.D.,
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- Ingalls Dialysis Center
- Laura Beth Ingalsbe, RN
- Dordana Elizabeth Ingram, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.