SHANEIKA GOULDBOURNE DMD
NPI 1629902937
Dentist - General Practice in Jefferson City, MO

Q: What is Shaneika Gouldbourne's NPI number?

The NPI number for Shaneika Gouldbourne is 1629902937. It was assigned to this individual provider in the NPPES registry on June 11, 2026.

Q: What is Shaneika Gouldbourne's specialty?

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

Active since June 11, 2026PECOS Enrolled

1511 CHRISTY DR, JEFFERSON CITY, MO 65101(573) 632-2777 Get Directions Write a Review

NPPES record last updated: June 11, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

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About Shaneika Gouldbourne Dmd NPPES

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

SHANEIKA GOULDBOURNE DMD (NPI 1629902937) is an individual general practice provider in Jefferson City, Missouri, licensed in Missouri (2026025306) and active in the NPI registry since June 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1629902937

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameSHANEIKA GOULDBOURNECredential: DMD

Location Address1511 CHRISTY DRJefferson City, MO 65101-2854

Mailing Address4900 Nw 18th CtLauderhill, FL 33313-4125 · (954) 982-3733

Phone(573) 632-2777

Sole ProprietorNo

Enumeration DateJune 11, 2026

NPPES CertifiedJune 11, 2026

✔ NPI 1629902937 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in MO · 2026025306

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.

1511 CHRISTY DR, Jefferson City, MO 65101

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shaneika Gouldbourne Dmd 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 65101 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

$81.64 typical visit price

range $52.28 – $161.24

Typical copayment $20.41 (range $13.07 – $40.31)

Most-billed visit code 99203

Established Patient

$65.71 typical visit price

range $16.30 – $131.05

Typical copayment $16.42 (range $4.07 – $32.76)

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 20

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

COMMUNITY HEALTH CTR OF CENTRAL MISSOURI

Pharmacy (Community/Retail Pharmacy)