Provider Demographics
NPI:1083713747
Name:SHEPHEARD, SHARNN AARIN (DDS)
Entity Type:Individual
Prefix:
First Name:SHARNN
Middle Name:AARIN
Last Name:SHEPHEARD
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 1:5495 OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3252
Mailing Address - Country:US
Mailing Address - Phone:877-442-8288
Mailing Address - Fax:
Practice Address - Street 1:1090 NORTHCHASE PKWY SE
Practice Address - Street 2:SUITE 290
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6405
Practice Address - Country:US
Practice Address - Phone:678-904-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011674122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100706Medicaid