NPIMap

Organization Active NPI

Dental Professionals of Virginia, P.C.

Doing business as Tinker Creek Dental Care

  • General Practice Dentistry
  • Roanoke, VA
National Provider Identifier
1790528784
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Doing business as
Tinker Creek Dental Care
Practice address
3911 Challenger Ave
Roanoke, VA 24012-6733
Phone
(540) 581-8095
Fax
(540) 581-8096
NPI assigned
Jun 17, 2024
Last updated
Jun 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF VIRGINIA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3911 Challenger Ave
Roanoke, VA 24012-6733

Mailing address

3911 Challenger Ave
Roanoke, VA 24012-6733
Phone (540) 581-8095

Other names 1

  • Tinker Creek Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Virginia PC69 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Virginia PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3911 Challenger Ave
Roanoke, VA 24012
Phone (540) 581-8095

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1790528784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 CHALLENGER AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240126733",
            "telephone_number": "540-581-8095",
            "fax_number": "540-581-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 CHALLENGER AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240126733",
            "telephone_number": "540-581-8095",
            "fax_number": "540-581-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF VIRGINIA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF VIRGINIA, P.C.",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tinker Creek Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 17, 2024; 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.