NPIMap

Individual provider Active NPI

Sheppard A. McKenzie IV, D.D.S.

  • Periodontics
  • Raleigh, NC
National Provider Identifier
1801068184
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
8007 Issued in NC
Practice address
7200 Stonehenge Dr Ste 104
Raleigh, NC 27613-1620
Phone
(919) 846-2480
Fax
(919) 846-2482
NPI assigned
Mar 27, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 8007 NC Primary

Addresses

Primary practice location

7200 Stonehenge Dr Ste 104
Raleigh, NC 27613-1620

Mailing address

7501 Falls of Neuse Road
Suite 100
Raleigh, NC 27615
Phone (919) 846-2480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8007NCMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Steven W. Hamrick, DMD, PA Periodontics Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1801068184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 FALLS OF NEUSE ROAD",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27615",
            "telephone_number": "919-846-2480",
            "fax_number": "919-846-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 STONEHENGE DR STE 104",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276131620",
            "telephone_number": "919-846-2480",
            "fax_number": "919-846-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "SHEPPARD",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-27",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "8007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; 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.