John Vernon Jetty, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

034169 Issued in NY

Practice address

86 Center St
Waterloo, NY 13165-1026

Phone

(315) 539-3051

Fax

(315) 539-3051

NPI assigned

Dec 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

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)

Enrolled

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689730327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 CENTER ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651026",
            "telephone_number": "315-539-3051",
            "fax_number": "315-539-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 CENTER ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651026",
            "telephone_number": "315-539-3051",
            "fax_number": "315-539-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETTY",
        "first_name": "JOHN",
        "middle_name": "VERNON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "034169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Waterloo, NY
• Providers in Waterloo, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.