Active NPI
Aisha Y Mulla, DDS
- General Practice Dentistry
- Alton, IL
National Provider Identifier
1972380202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.034391
- Practice address
- 2800 College Ave
Alton, IL 62002-4700 - Phone
- (618) 474-7000
- NPI assigned
- Sep 11, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.034391 | IL | Primary |
Addresses
Primary practice location
2800 College Ave
Alton, IL 62002-4700
Mailing address
288 Hickory Hedge Dr
Ballwin, MO 63021-5731
Phone (573) 529-7642
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 |
|---|---|---|---|
| 019.034391 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1972380202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "288 HICKORY HEDGE DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630215731",
"telephone_number": "573-529-7642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 COLLEGE AVE",
"city": "ALTON",
"state": "IL",
"postal_code": "620024700",
"telephone_number": "618-474-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLA",
"first_name": "AISHA",
"middle_name": "Y",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-11",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.034391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.