Individual
AISHWARYA INDIRAMOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
802 N 9TH ST, SPRINGFIELD, IL 62702-6309
(888) 988-4066
(847) 496-7603
Mailing address
5700 EDWARDS RANCH RD STE 100, FORT WORTH, TX 76109-4128
(817) 292-2004
(178) 292-7083
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.029137
IL
1223P0221X
Pediatric Dentistry
Primary
31773
TX
Other
Enumeration date
07/18/2012
Last updated
06/09/2021
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