Provider Demographics
NPI:1003926940
Name:SHELBURNE, ROY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:S
Last Name:SHELBURNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37166 WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-8085
Mailing Address - Country:US
Mailing Address - Phone:276-346-3863
Mailing Address - Fax:276-346-3944
Practice Address - Street 1:14245 LEE HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-4317
Practice Address - Country:US
Practice Address - Phone:276-628-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0057981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA109356Medicaid