Provider Demographics
NPI:1295180933
Name:SHETTY VITTAL, KEERTHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEERTHI
Middle Name:
Last Name:SHETTY VITTAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 HANDWERG DR
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6410
Mailing Address - Country:US
Mailing Address - Phone:201-783-9889
Mailing Address - Fax:
Practice Address - Street 1:359 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4311
Practice Address - Country:US
Practice Address - Phone:201-385-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1026155001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice