Provider Demographics
NPI:1891807046
Name:SHEPP, CARL RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:RICHARD
Last Name:SHEPP
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-0368
Mailing Address - Country:US
Mailing Address - Phone:406-273-2015
Mailing Address - Fax:406-273-2782
Practice Address - Street 1:5577 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6845
Practice Address - Country:US
Practice Address - Phone:406-273-2015
Practice Address - Fax:406-273-2782
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184385551OtherTYPE 2 NPI
MT5511428OtherMT STATE CHIP PROGRAM
MT0111673Medicaid