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ROANNE SHOUBAKI
NPI 1053005504
Dentist - General Practice in Georgetown, TX

Active since June 07, 2023PECOS Enrolled
2411 WILLIAMS DR STE 111, GEORGETOWN, TX 78628(877) 800-5722 Get Directions Write a Review

NPPES record last updated: July 17, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 12, 2023, Jun 7, 2023 (2 updates tracked since 2023).

About Roanne Shoubaki NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROANNE SHOUBAKI (NPI 1053005504) is an individual general practice provider in Georgetown, Texas, licensed in Texas (39434) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053005504
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameROANNE SHOUBAKI
Location Address2411 WILLIAMS DR STE 111Georgetown, TX 78628-3268
Mailing Address2423 Williams Dr Ste 107Georgetown, TX 78628-3269 · (877) 800-5722
Phone(877) 800-5722
Sole ProprietorYes
Enumeration DateJune 7, 2023
Last NPPES UpdateJuly 17, 20252 updates tracked since enumeration
NPPES CertifiedJuly 17, 2025
✔ NPI 1053005504 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in TX · 39434
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Also ListedDentistTaxonomy 122300000X · License 39434 (TX)
2411 WILLIAMS DR STE 111, Georgetown, TX 78628
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Roanne Shoubaki is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78628 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NANDITHA RAO
Dentist (General Practice)
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722
MRS. APRIL DIANE DOUGHARTY RDH
Dental Hygienist
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722
BETHANY ANN RAWLINSON DDS
Dentist
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722
DIANA TERUKO VAUGHT
Dentist (General Practice)
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722
DR. NETSANET TEMESGEN D.D.S.
Dentist (General Practice)
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722
CELIA ANN TAYS D.M.D.
Dentist (General Practice)
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722
GUADALUPE LEZAMA DE SOLAR RDH
Dental Hygienist
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (512) 864-1445
RAJAT DIWAN D.D.S.,
Dentist (General Practice)
2411 WILLIAMS DR STE 111
GEORGETOWN, TX 78628
Williamson County (877) 800-5722

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roanne Shoubaki's NPI number?

The NPI number for Roanne Shoubaki is 1053005504. It was assigned to this individual provider in the NPPES registry on June 7, 2023.

Where is Roanne Shoubaki located?

Roanne Shoubaki practices at 2411 Williams Dr Ste 111, Georgetown, TX 78628. The listed phone number is (877) 800-5722.

What is Roanne Shoubaki's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Roanne Shoubaki enrolled in Medicare?

Yes. Roanne Shoubaki is registered in the Medicare PECOS enrollment system.

What insurance does Roanne Shoubaki accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 14 other insurers list Roanne Shoubaki as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Roanne Shoubaki was last updated on July 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.