Roy S Shelburne, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401-005798 Issued in VA

Practice address

14245 Lee Hwy
Bristol, VA 24202-4317

Phone

(276) 628-8164

NPI assigned

Aug 30, 2006

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

Opted out of Medicare

Previously, effective Aug 12, 2018 through Aug 12, 2026

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Roy S. Shelburne, DDS, LTD

  • Dentist
  • Pennington Gap, VA
  • NPI 1992826804
  NPD (past) Authorized official
• Lee Family Dental PLC

  • General Practice Dentistry
  • Pennington Gap, VA
  • NPI 1730336173
  NPD (past)
• Ronald D Jessup DMD PC

  • General Practice Dentistry
  • Bristol, VA
  • NPI 1396706669
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488758400000",
    "number": "1003926940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37166 WILDERNESS RD",
            "city": "JONESVILLE",
            "state": "VA",
            "postal_code": "242638085",
            "telephone_number": "276-346-3863",
            "fax_number": "276-346-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14245 LEE HWY",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242024317",
            "telephone_number": "276-628-8164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELBURNE",
        "first_name": "ROY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401-005798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Marion Seaver, DDS
• Kaushal Yogeshbhai Shah, MD
• Ryan W Shao, M.D.
• Kathy Lynne Sharp, NP
• Kimberly Stines Sheets, LCSW
• Bradley Craig Shortt, LPC
• Joanna Sloggy, PHD, CCC-SLP
• Albert Smith, PT, DPT
• Sonya K. Martin DDS LLC
• South Holston Dental Designs

• General Practice Dentistry in Bristol, VA
• Providers in Bristol, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.