Vijayata Gupta, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901020281 Issued in MI

Practice address

15100 W. Library LN.
New Berlin, WI 53151

Phone

(262) 641-0056

Fax

(262) 641-0058

NPI assigned

Aug 12, 2010

Last updated

Feb 4, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Vijayata Manuballa Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Wisconsin Dental Group, S.C.

  dba ForwardDental New Berlin

  • Pediatric Dentistry
  • New Berlin, WI
  • NPI 1952431090
  NPD (past)

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1275848350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15100 W. LIBRARY LN.",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "53151",
            "telephone_number": "262-641-0056",
            "fax_number": "262-641-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15100 W. LIBRARY LN.",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "53151",
            "telephone_number": "262-641-0056",
            "fax_number": "262-641-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "VIJAYATA",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIJAYATA",
            "last_name": "MANUBALLA",
            "prefix": "MS.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cristina Andrea Grieben, M.D.
• Rochelle M Griffin, O.T.
• Devin Jamie Grosklaus
• Jeffrey John Gruchalski, DDS
• Jon James Gruchalski, DDS
• Michael Gutzeit, M.D.
• Mary Gutzke
• Lynn M Guy, O.T.
• Sarah Marie Hagen, RN
• Anna Hahn, LAT, ATC

• 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 Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.