Jacob Teel Shelburne, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401417476 Issued in VA

Practice address

616 Campus Dr Ste 100
Abingdon, VA 24210-9706

Phone

(276) 525-4487

NPI assigned

Jun 24, 2021

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Mission Dental Virginia, Inc

  • General Practice Dentistry
  • Abingdon, VA
  • NPI 1639785934
  NPD

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1629647458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 FOREST LODGE DR",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242666189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 CAMPUS DR STE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242109706",
            "telephone_number": "276-525-4487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELBURNE",
        "first_name": "JACOB",
        "middle_name": "TEEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annie Sensabaugh, LCSW
• Allison Nicole Sexton, FNP
• Majd Shamma, MD
• Jordan Nicole Sheets, LCSW
• Morgan Sheets
• Christina Shelton, PHARMD, BCPS
• Carrie Lee Sheppard, CRNA
• Emily Simoson Shields, M.D.
• Bradley Shockley, DPT, HFS
• Amanda Nicole Shortridge, FNP-C

• Dentist in Abingdon, VA
• Providers in Abingdon, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.