Provider Demographics
NPI:1760046254
Name:SHEPPARD DENTAL HEALTH AND ASSOCIATES
Entity Type:Organization
Organization Name:SHEPPARD DENTAL HEALTH AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-732-8600
Mailing Address - Street 1:3096 W M 32
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9753
Mailing Address - Country:US
Mailing Address - Phone:989-732-8600
Mailing Address - Fax:
Practice Address - Street 1:3096 W M 32
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9753
Practice Address - Country:US
Practice Address - Phone:989-732-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1861787350OtherPROVIDER NPI