Provider Demographics
NPI:1043339716
Name:BER, SHEARD ADOLPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEARD
Middle Name:ADOLPH
Last Name:BER
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 1:1711 HIMALAYA AVE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5309
Mailing Address - Country:US
Mailing Address - Phone:985-446-5031
Mailing Address - Fax:985-446-7458
Practice Address - Street 1:1711 HIMALAYA AVE
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5309
Practice Address - Country:US
Practice Address - Phone:985-446-5031
Practice Address - Fax:985-446-7458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA19741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice