Active NPI
Tyheisha Krystal Roach, DDS
- Dentist
- Norfolk, VA
National Provider Identifier
1053834556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401415754
- Practice address
- Naval Medical Center Portsmouth
620 John Paul Jones Circle
Norfolk, VA 23708 - Phone
- (757) 953-8591
- NPI assigned
- Jul 18, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401415754 | VA | Primary |
Addresses
Primary practice location
Naval Medical Center Portsmouth
620 John Paul Jones Circle
Norfolk, VA 23708
Mailing address
Naval Medical Center Portsmouth
620 John Paul Jones Circle
Portsmouth, VA 23708
Phone (757) 953-8509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401415754 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1053834556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NAVAL MEDICAL CENTER PORTSMOUTH",
"address_2": "620 JOHN PAUL JONES CIRCLE",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "23708",
"telephone_number": "757-953-8509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAL MEDICAL CENTER PORTSMOUTH",
"address_2": "620 JOHN PAUL JONES CIRCLE",
"city": "NORFOLK",
"state": "VA",
"postal_code": "23708",
"telephone_number": "757-953-8591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "TYHEISHA",
"middle_name": "KRYSTAL",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-18",
"last_updated": "2022-03-17",
"certification_date": "2022-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401415754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.