Provider Demographics
NPI:1407548720
Name:SHEPARD, SERINA (DMD)
Entity Type:Individual
Prefix:
First Name:SERINA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3168 NW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3020
Mailing Address - Country:US
Mailing Address - Phone:772-777-9815
Mailing Address - Fax:
Practice Address - Street 1:5693 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3160
Practice Address - Country:US
Practice Address - Phone:954-757-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist