Provider Demographics
NPI:1598823700
Name:SHEPARD, BRADLEY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DEAN
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BATTERY ST
Mailing Address - Street 2:#910
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111
Mailing Address - Country:US
Mailing Address - Phone:415-982-4277
Mailing Address - Fax:415-982-1535
Practice Address - Street 1:22 BATTERY ST
Practice Address - Street 2:#910
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111
Practice Address - Country:US
Practice Address - Phone:415-982-4277
Practice Address - Fax:415-982-1535
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist