Active NPI
Sravanthi Papisetti, BDS
- Periodontics
- Fort Wayne, IN
National Provider Identifier
1912429994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12013928A
- Practice address
- 1320 Medical Park Dr
Fort Wayne, IN 46825-5844 - Phone
- (304) 384-0608
- NPI assigned
- Jul 12, 2017
- Last updated
- Apr 5, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 12013928A | IN | Primary |
Addresses
Primary practice location
1320 Medical Park Dr
Fort Wayne, IN 46825-5844
Mailing address
545 Overture Dr
Fort Wayne, IN 46845-0076
Phone (304) 384-0608
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013928A | IN | MD | Periodontist |
| 12055 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680652800000",
"number": "1912429994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 OVERTURE DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468450076",
"telephone_number": "304-384-0608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1320 MEDICAL PARK DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255844",
"telephone_number": "304-384-0608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAPISETTI",
"first_name": "SRAVANTHI",
"credential": "BDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-12",
"last_updated": "2023-04-05",
"certification_date": "2023-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "12013928A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.