NPIMap

Organization Active NPI

Roanoke Pediatric Dentistry, LLC

  • Pediatric Dentistry
  • Roanoke, VA
National Provider Identifier
1255841433
Registry record updated Oct 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401413481 Issued in VA
Legal business name
ROANOKE PEDIATRIC DENTISTRY, LLC
Practice address
6112 Peters Creek Rd
Roanoke, VA 24019-4028
Phone
(540) 563-1660
NPI assigned
Oct 2, 2017
Last updated
Oct 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2017

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

Authorized official

Name
Dr. Corey Joe Sheppard, DDS
Title
Owner
Phone
(540) 563-1660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 0401413481 VA Primary

Addresses

Primary practice location

6112 Peters Creek Rd
Roanoke, VA 24019-4028

Mailing address

6112 Peters Creek Rd
Roanoke, VA 24019-4028
Phone (540) 563-1660

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506902400000",
    "number": "1255841433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6112 PETERS CREEK RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240194028",
            "telephone_number": "540-563-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6112 PETERS CREEK RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240194028",
            "telephone_number": "540-563-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-02",
        "last_updated": "2017-10-02",
        "status": "A",
        "authorized_official_last_name": "SHEPPARD",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-563-1660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401413481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.