NPIMap

Organization Active NPI

Roy S. Shelburne, DDS, LTD

  • Dentist
  • Pennington Gap, VA
National Provider Identifier
1992826804
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401-005798 Issued in VA
Legal business name
ROY S. SHELBURNE, DDS, LTD
Practice address
153 E Morgan Ave
Pennington Gap, VA 24277-2643
Phone
(276) 546-2042
Fax
(276) 546-3029
NPI assigned
Apr 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Roy Silas Shelburne, D.D.S.NPI 1003926940
Title
President
Phone
(276) 546-2042

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 0401-005798 VA Primary

Addresses

Primary practice location

153 E Morgan Ave
Pennington Gap, VA 24277-2643

Mailing address

153 E Morgan Ave
Pennington Gap, VA 24277-2643
Phone (276) 546-2042

Other identifiers 1

IdentifierTypeStateIssuer
9177403MedicaidVA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992826804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 E MORGAN AVE",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242772643",
            "telephone_number": "276-546-2042",
            "fax_number": "276-546-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 E MORGAN AVE",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242772643",
            "telephone_number": "276-546-2042",
            "fax_number": "276-546-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROY S. SHELBURNE, DDS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHELBURNE",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "SILAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "276-546-2042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401-005798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9177403",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pennington Gap, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.