DR. SHAD DEMAR ROUNDY (NPI# 1164492104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164492104 |
| Entity Type | Individual |
| Full Name | DR. SHAD DEMAR ROUNDY |
| Credential | DMD |
| Practice Address |
1601 Medical Arts Blvd Ste 301 Anderson IN 46011-3460 |
| Practice Telephone | 7652984400 |
| Practice Fax Number | 7652984940 |
| Mailing Telephone | 7652984400 |
| Mailing Fax Number | 7652984940 |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2015-08-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12012276B | IN | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12012276A | IN | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
173 | AK | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FEDERAL DEA | BR9479444 | 01 | |
| FEDERAL DEA ANDERSON, IN | FR5170701 | 01 | |
| AK | DD0083 | 05 | |
| DEA | FR 2350419 | 01 |
| Street Address |
1601 MEDICAL ARTS BLVD STE 301 |
| City | ANDERSON |
| State | IN |
| Zip Code | 46011-3460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124662226 | Full Circle Family Solutions, LLC | Counselor | 909 Northwood Drive, Anderson, IN 46011 | 2019-10-31 |
| 1497186563 | Andrea C Rich | Social Worker | 1317 Winding Way, Anderson, IN 46011 | 2013-11-27 |
| 1093080848 | Franklin Keith Beeler | Family Medicine | 930 Summerlin Court, Anderson, IN 46011 | 2012-03-13 |
| 1063609642 | Christopher Place At Keystone Woods Associates, LLC | Assisted Living Facility | 2334 North Madison Ave, Anderson, IN 46011 | 2007-09-27 |
| 1720155187 | Garry L Smith Dds PC | Dentist | 1528 Medical Arts Blvd, Anderson, IN 46011 | 2006-11-29 |
| 1891711586 | Suzanne Obrien Beeson | Psychologist | 1210 Medical Arts. Blvd., Suite 208, Anderson, IN 46011 | 2006-07-14 |
| 1669471199 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 1809 N Madison Ave, Anderson, IN 46011 | 2005-07-18 |
| 1265980742 | Andrew J Koehler | Counselor | 2010 Brentwood Dr, Anderson, IN 46011 | 2016-09-14 |
| 1902258866 | Audrey A. Dickerson | Physician Assistant | 1515 N Madison Ave, Anderson, IN 46011 | 2016-07-05 |
| 1104271790 | Mohammad Sami Bakdash | Internal Medicine | 1515 N Madison Ave, Anderson, IN 46011 | 2016-05-02 |
| Find all providers in zip 46011 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598173627 | Blue Ridge Oral and Maxillofacial Surgery Pa | Dentist | 209 E Highland Ave, Anderson, SC 29621-4711 | 2014-08-01 |
| 1134549629 | Foothills Oral & Facial Surgery | Dentist | 301 W Beltline Blvd, #301, Anderson, SC 29625-1505 | 2014-04-23 |
| 1326173428 | Anderson Oral and Maxillofacial Surgery, Pa | Dentist | 1209 Ella Street, Anderson, SC 29621 | 2007-02-22 |
| 1003978586 | Chris D Kinney | Dentist | 3825 Fairview Dr, Anderson, IN 46013 | 2006-12-14 |
| 1568538098 | Oral and Maxillofacial Surgery of Anderson,llc | Dentist | 1514 North Fant Street, Anderson, SC 29621-4708 | 2006-11-27 |
| 1225011323 | Lewis Tyler Sumner | Dentist | 1209 Ella St, Anderson, SC 29621-4811 | 2005-11-22 |
| 1891172797 | Anderson Oral and Maxillofacial Surgery | Dentist | 1601 Medical Arts Blvd, Suite 3, Anderson, IN 46011-3458 | 2015-04-29 |
| 1457628711 | Chris D. Kinney, D.d.s. P.C. | Dentist | 3825 Fairview Dr, Anderson, IN 46013-4059 | 2011-11-30 |
| 1649316241 | William S. Dunlap Jr. | Dentist | 1514 North Fant Street, Anderson, SC 29621-4708 | 2007-01-30 |
| 1740386242 | Howard H. Mohler Dds Inc | Dentist | 1601 Medical Arts Blvd, Suite 301, Anderson, IN 46011-3458 | 2006-09-15 |
| Find all providers in ANDERSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.