John Scott Repass Sr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401003883 Issued in VA

Practice address

102 Highland Ave SE
301 Community Medical BLDG
Roanoke, VA 24013-2253

Phone

(540) 343-1769

Fax

(540) 342-1606

NPI assigned

Jul 29, 2007

Last updated

Jul 29, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1185667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185667200000",
    "number": "1619167319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 HIGHLAND AVE SE",
            "address_2": "301 COMMUNITY MEDICAL BLDG",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240132253",
            "telephone_number": "540-343-1769",
            "fax_number": "540-342-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 HIGHLAND AVE SE",
            "address_2": "301 COMMUNITY MEDICAL BLDG",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240132253",
            "telephone_number": "540-343-1769",
            "fax_number": "540-342-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REPASS",
        "first_name": "JOHN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-29",
        "last_updated": "2007-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401003883",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "3883",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Roanoke, VA
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• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2007; 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.