Provider Demographics
NPI:1871507004
Name:SHEPPELMAN, ANTOINETTE MINNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:MINNIE
Last Name:SHEPPELMAN
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 1:1620 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3513
Mailing Address - Country:US
Mailing Address - Phone:318-746-2692
Mailing Address - Fax:
Practice Address - Street 1:1620 BENTON RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3513
Practice Address - Country:US
Practice Address - Phone:318-746-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice