NPIMap

Organization Active NPI

Roanoke Smiles Youth Dentistry, LLC

  • General Practice Dentistry
  • Roanoke, VA
National Provider Identifier
1851489116
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ROANOKE SMILES YOUTH DENTISTRY, LLC
Practice address
5002 Airport Rd NW
Unit 130
Roanoke, VA 24012-1608
Phone
(540) 362-5437
Fax
(540) 362-8997
NPI assigned
Oct 11, 2006
Last updated
Jul 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Authorized official

Name
Mrs. Jenell Stump
Title
Manager
Phone
(615) 750-0343

Specialties & licenses 1

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

Addresses

Primary practice location

5002 Airport Rd NW
Unit 130
Roanoke, VA 24012-1608

Mailing address

16 Arcade Unit 198747
Nashville, TN 37219-1994
Phone (615) 750-0343

Other identifiers 1

IdentifierTypeStateIssuer
109481MedicaidVA

National Provider Directory

National Provider Directory

Locations

16 Arcade
Unit 198747
Nashville, TN 37219

5002 Airport Rd NW
Ste 130
Roanoke, VA 24012
Phone (540) 362-5437

Practitioners & affiliated clinicians

Practitioners 8

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": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1851489116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5002 AIRPORT RD NW",
            "address_2": "UNIT 130",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240121608",
            "telephone_number": "540-362-5437",
            "fax_number": "540-362-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE SMILES YOUTH DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109481",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 9, 2014; 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.