Keerthi Shabadu, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1002553-15 Issued in WI

Practice address

15100 Library LN
New Berlin, WI 53151-5291

Phone

(262) 641-0056

NPI assigned

Jun 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisconsin Dental Group, S.C.

  • Pediatric Dentistry
  • New Berlin, WI
  • NPI 1952431090
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1073181608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2332 MILLBROOK LOOP",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786411510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15100 LIBRARY LN",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531515291",
            "telephone_number": "262-641-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABADU",
        "first_name": "KEERTHI",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002553-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lee Schuster, MS
• Christopher J Schwake, M.D.
• Nichole N Sciaccotta, APNP
• Anthony Ronald Scott Seidl
• Joseph Charles Serflek, DDS
• Margaret Louise Shane, OT
• Lisa Sheehan
• Cynthia Louise Shicotte, MA, CCC/SLP
• Maryam Shittu, MD
• Ali H Siddiqui, MD

• General Practice Dentistry in New Berlin, WI
• Providers in New Berlin, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.

Verify at the official NPI Registry.