Individual provider Active NPI

Shahrzad Orenduff, D.D.S.

  • General Practice Dentistry
  • Richmond, VA
National Provider Identifier
1003229733
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401417708 Issued in VA
Practice address
520 N 12TH St
Richmond, VA 23298-5064
Phone
(804) 828-9190
NPI assigned
Jun 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901022515 MI
General Practice Dentistry 1223G0001X 9775 NC
General Practice Dentistry 1223G0001X 0401417708 VA Primary

Addresses

Primary practice location

520 N 12TH St
Richmond, VA 23298-5064

Mailing address

5000 Libbie Mill East Blvd Apt 173
Richmond, VA 23230-2115
Phone (757) 810-0373

Other practice location 1

15 Rawls Rd
Suite 100
Angier, NC 27501-6033
Phone (919) 639-0264 ext. 10

Other practice location 2

21055 E 12 Mile Rd
Roseville, MI 48066-2205
Phone (586) 772-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220114001692 VA Practitioner - Dentist 0446540926 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901022515MIMDDentist
9775NCMDGeneral Practice Dentistry
0401417708VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Total Sleep PLLC Dentist CurrentSince Jan 5, 2022 Accepting new patients
Virginia Total Sleep PLLC Dentist CurrentSince Jan 5, 2022 Accepting new patients
Wdwrosevillepllc General Practice PastSince Jul 25, 2019 Accepting new patients
Carl Papa D.D.S., P.C. Dentist PastSince Jul 25, 2019 Accepting new patients

Locations

10120 W Broad St
Ste I
Glen Allen, VA 23060
Phone (804) 625-4064

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1003229733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 LIBBIE MILL EAST BLVD APT 173",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232302115",
            "telephone_number": "757-810-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 12TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985064",
            "telephone_number": "804-828-9190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Rawls Rd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Angier",
            "state": "NC",
            "postal_code": "275016033",
            "country_code": "US",
            "telephone_number": "919-639-0264 x10",
            "fax_number": "919-331-0239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21055 E 12 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "MI",
            "postal_code": "480662205",
            "country_code": "US",
            "telephone_number": "586-772-0100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ORENDUFF",
        "first_name": "SHAHRZAD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-10",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901022515",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "9775",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.