Shane Roberson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

106200 Issued in CA

Practice address

9510 Hageman Rd Ste B
Bakersfield, CA 93312-3953

Phone

(661) 829-2700

NPI assigned

Jun 7, 2021

Sex

Male

Sole proprietor

No

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

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Huynh and Watanabe Dental Corporation

  dba River Lakes Dental Group

  • General Practice Dentistry
  • Bakersfield, CA
  • NPI 1225137573
  NPD (past)

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1083281240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9315 CHINOOK AVE",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933123950",
            "telephone_number": "661-301-8869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 HAGEMAN RD STE B",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933123953",
            "telephone_number": "661-829-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-07",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Jo Robb, NP
• Dale A. Robbins, PA-C
• Hillary Robbins
• Jennifer Kay Robbins, LCSW
• Dawn Marie Roberson
• Robert a. Smith, DMD Inc.
• Robert L Laughlin MD Inc
• Robert L Waguespack MD, Apc
• Ranon Rodolfo Gaddi Roberto
• Nala Roberts Wright

• Dentist in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.