Provider Demographics
NPI:1851420665
Name:SHEPPARD, JOAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:A
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10545 MORGAN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3434
Mailing Address - Country:US
Mailing Address - Phone:952-346-0020
Mailing Address - Fax:
Practice Address - Street 1:1601 HIGHWAY 13 E
Practice Address - Street 2:SUITE 105
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6865
Practice Address - Country:US
Practice Address - Phone:952-890-5450
Practice Address - Fax:952-707-1122
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND88681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice