Provider Demographics
NPI:1629315643
Name:JOHN DAVID SHEPHERD D.M.D.
Entity Type:Organization
Organization Name:JOHN DAVID SHEPHERD D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-987-4055
Mailing Address - Street 1:2006 OLD MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1658
Mailing Address - Country:US
Mailing Address - Phone:205-987-4055
Mailing Address - Fax:205-987-4635
Practice Address - Street 1:2006 OLD MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1658
Practice Address - Country:US
Practice Address - Phone:205-987-4055
Practice Address - Fax:205-987-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3970261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental