Keerthi Shetty Vittal, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22D102615500 Issued in NJ

Practice address

359 S Washington Ave
Bergenfield, NJ 07621-4311

Phone

(201) 385-2500

NPI assigned

May 2, 2016

Last updated

Mar 17, 2018By the provider in NPPES

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

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1295180933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 HANDWERG DR",
            "city": "RIVER VALE",
            "state": "NJ",
            "postal_code": "076756410",
            "telephone_number": "201-783-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 S WASHINGTON AVE",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076214311",
            "telephone_number": "201-385-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Centennial Ave",
            "address_purpose": "LOCATION",
            "city": "Piscataway",
            "state": "NJ",
            "postal_code": "088544152",
            "country_code": "US",
            "telephone_number": "732-562-8555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHETTY VITTAL",
        "first_name": "KEERTHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22D102615500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ehab Tanios Shahid, DMD
• Serena Shammas, PHARM.D
• Zena Shammas, RPH
• Sara Vickers Shapiro, MSW, LMSW, LCSW
• Sher Counseling Services
• Sapna Shukla, OD
• Xavier Aldiano Sibug, COTA
• Sunil S Singh
• Albert Siu, M.D.
• Skilled Physical Therapy LLC

• General Practice Dentistry in Bergenfield, NJ
• Providers in Bergenfield, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.