Provider Demographics
NPI:1407973977
Name:JOHN E SHEPPARD DDS PA
Entity Type:Organization
Organization Name:JOHN E SHEPPARD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-589-8012
Mailing Address - Street 1:PO BOX 8548
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-8548
Mailing Address - Country:US
Mailing Address - Phone:856-589-8012
Mailing Address - Fax:856-589-8013
Practice Address - Street 1:438 GANTTOWN RD
Practice Address - Street 2:SUITE A6
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2341
Practice Address - Country:US
Practice Address - Phone:856-589-8012
Practice Address - Fax:856-589-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011773001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty