J Shane Roberts, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4013 Issued in AL

Practice address

904 4TH St
Pleasant Grove, AL 35127-1059

Phone

(205) 744-4258

Fax

(205) 744-4255

NPI assigned

May 18, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• J. Shane Roberts Family Dentistry

  • Dental Clinic/Center
  • Pleasant Grove, AL
  • NPI 1861910036
  NPD (past)

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710195466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 445",
            "city": "PLEASANT GROVE",
            "state": "AL",
            "postal_code": "351270445",
            "telephone_number": "205-744-4258",
            "fax_number": "205-744-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 4TH ST",
            "city": "PLEASANT GROVE",
            "state": "AL",
            "postal_code": "351271059",
            "telephone_number": "205-744-4258",
            "fax_number": "205-744-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "J",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "4013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "15995",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROV #",
            "identifier": "87708",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pleasant Grove Drugs Inc.
• Pleasant Grove Nursing and Rehabilitation Center LLC
• Ebony Watkins Pollard, PHARM.D.
• Adina Rasheed
• Cassandra Denise Reedy
• Brian Andrew Rudolph
• Latanya Sharpe
• Charmaine Junia Smith, FNP
• Hali Renee Smith, PHARMD
• Jeffery Jack Solomon, DMD

• General Practice Dentistry in Pleasant Grove, AL
• Providers in Pleasant Grove, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.