Provider Demographics
NPI:1548574940
Name:ANDREW D. SHEPHARD, DDS, LLC
Entity Type:Organization
Organization Name:ANDREW D. SHEPHARD, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHEPHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-464-9061
Mailing Address - Street 1:625 W MILL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3963
Mailing Address - Country:US
Mailing Address - Phone:812-464-9061
Mailing Address - Fax:812-464-8737
Practice Address - Street 1:625 W MILL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3963
Practice Address - Country:US
Practice Address - Phone:812-464-9061
Practice Address - Fax:812-464-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011488A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental