Provider Demographics
NPI:1770638439
Name:SHEPPARD, ERNEST E (DDS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:E
Last Name:SHEPPARD
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 1:4206 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8331
Mailing Address - Country:US
Mailing Address - Phone:580-355-3065
Mailing Address - Fax:580-355-3084
Practice Address - Street 1:4206 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8331
Practice Address - Country:US
Practice Address - Phone:580-355-3065
Practice Address - Fax:580-355-3084
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice