Provider Demographics
NPI:1497210546
Name:SPRINGFIELD PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SPRINGFIELD PEDIATRIC DENTISTRY
Other - Org Name:SIRISHA GOVINDAIAH DDS, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVINDAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MPH, DDS
Authorized Official - Phone:217-666-0098
Mailing Address - Street 1:10900 FOX CRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-7249
Mailing Address - Country:US
Mailing Address - Phone:217-666-0098
Mailing Address - Fax:
Practice Address - Street 1:1224 CENTRE WEST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2184
Practice Address - Country:US
Practice Address - Phone:217-666-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty