NPIMap

Organization Active NPI

Justin N Tebbenkamp DDS PC

  • Dentist
  • Blacksburg, VA
National Provider Identifier
1831408178
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401412219 Issued in VA
Legal business name
JUSTIN N TEBBENKAMP DDS PC
Practice address
1305 N Main St
Blacksburg, VA 24060-3129
Phone
(540) 961-3279
NPI assigned
Oct 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Dr. Justin Neil Tebbenkamp, DDSNPI 1316102296
Title
Owner/President
Phone
(540) 961-3279

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 0401412219 VA Primary

Addresses

Primary practice location

1305 N Main St
Blacksburg, VA 24060-3129

Mailing address

1305 N Main St
Blacksburg, VA 24060-3129
Phone (540) 961-3279

National Provider Directory

National Provider Directory

Locations

1305 N Main St
Blacksburg, VA 24060
Phone (540) 961-3279

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1831408178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 N MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240603129",
            "telephone_number": "540-961-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 N MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240603129",
            "telephone_number": "540-961-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN N TEBBENKAMP DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "TEBBENKAMP",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "540-961-3279",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blacksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.