Provider Demographics
NPI:1598969727
Name:SITTASON, SHEPHERD (DDS)
Entity Type:Individual
Prefix:
First Name:SHEPHERD
Middle Name:
Last Name:SITTASON
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 1:105 PAULETTE CIR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3150
Mailing Address - Country:US
Mailing Address - Phone:434-237-0125
Mailing Address - Fax:434-237-0498
Practice Address - Street 1:105 PAULETTE CIR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3150
Practice Address - Country:US
Practice Address - Phone:434-237-0125
Practice Address - Fax:434-237-0498
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0140144118001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry