Provider Demographics
NPI:1578153540
Name:WILLIAM T SHEPHERD, JR DDS
Entity Type:Organization
Organization Name:WILLIAM T SHEPHERD, JR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TOLER
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:870-535-0301
Mailing Address - Street 1:1242 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7109
Mailing Address - Country:US
Mailing Address - Phone:870-535-0301
Mailing Address - Fax:870-535-5724
Practice Address - Street 1:1242 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7109
Practice Address - Country:US
Practice Address - Phone:870-535-0301
Practice Address - Fax:870-535-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental