Provider Demographics
NPI:1316183486
Name:SHEPHERD, RENEE JEANETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:JEANETTE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SHAVANO PEAK DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-6084
Mailing Address - Country:US
Mailing Address - Phone:303-944-4586
Mailing Address - Fax:
Practice Address - Street 1:6160 FIRESTONE BLVD
Practice Address - Street 2:#105
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6427
Practice Address - Country:US
Practice Address - Phone:303-532-3371
Practice Address - Fax:303-532-3375
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice