Provider Demographics
NPI:1467751388
Name:SHEPHERD LANE DENTAL
Entity Type:Organization
Organization Name:SHEPHERD LANE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOLLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-416-5755
Mailing Address - Street 1:1103 S JOSEY LN
Mailing Address - Street 2:STE 707
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-7680
Mailing Address - Country:US
Mailing Address - Phone:972-416-5755
Mailing Address - Fax:972-820-6089
Practice Address - Street 1:383 HUFFINES PLZ
Practice Address - Street 2:STE 380
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-4674
Practice Address - Country:US
Practice Address - Phone:972-956-9200
Practice Address - Fax:972-956-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22654122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty