Provider Demographics
NPI:1770643371
Name:SHEPHERD, STEPHEN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:35772
Mailing Address - Country:US
Mailing Address - Phone:256-437-2191
Mailing Address - Fax:256-437-1066
Practice Address - Street 1:105 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AZ
Practice Address - Zip Code:35772
Practice Address - Country:US
Practice Address - Phone:256-437-2191
Practice Address - Fax:256-437-1066
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist