Provider Demographics
NPI:1023130275
Name:SHEPHERD, WALTER NEAL (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:NEAL
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 1:3285 BLAZER PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-264-1854
Mailing Address - Fax:859-264-1855
Practice Address - Street 1:3285 BLAZER PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-264-1854
Practice Address - Fax:859-264-1855
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics