Provider Demographics
NPI:1962460873
Name:SHEPARD, LOUIS ERVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ERVIN
Last Name:SHEPARD
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 1:807 S PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3527
Mailing Address - Country:US
Mailing Address - Phone:864-859-0111
Mailing Address - Fax:864-859-0112
Practice Address - Street 1:807 S PENDLETON ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3527
Practice Address - Country:US
Practice Address - Phone:864-859-0111
Practice Address - Fax:864-859-0112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX1450Medicaid