Provider Demographics
NPI:1750690111
Name:SHETTY, RESHMA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RESHMA
Middle Name:D
Last Name:SHETTY
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 1:135 MONTGOMERY ST APT 16F
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4628
Mailing Address - Country:US
Mailing Address - Phone:732-979-8008
Mailing Address - Fax:
Practice Address - Street 1:135 MONTGOMERY ST APT 16F
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4628
Practice Address - Country:US
Practice Address - Phone:732-979-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02450100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist