Active NPI
Kathryn Irene Vitiello, DMD
- Pediatric Dentistry
- Medford, MA
National Provider Identifier
1619476058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN15732
- Practice address
- 72 Woburn St
Medford, MA 02155-3419 - Phone
- (781) 710-2163
- NPI assigned
- Feb 11, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN15732 | MA | Primary |
Addresses
Primary practice location
72 Woburn St
Medford, MA 02155-3419
Mailing address
72 Woburn St
Medford, MA 02155-3419
Phone (781) 710-2163
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN15732 | MA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518307200000",
"number": "1619476058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 WOBURN ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021553419",
"telephone_number": "781-710-2163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 WOBURN ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021553419",
"telephone_number": "781-710-2163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITIELLO",
"first_name": "KATHRYN",
"middle_name": "IRENE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-11",
"last_updated": "2018-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DN15732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.