Provider Demographics
NPI:1245513878
Name:SHEPPARD, BRIAN D
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-2180
Mailing Address - Country:US
Mailing Address - Phone:650-726-3355
Mailing Address - Fax:650-726-5234
Practice Address - Street 1:890 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-2180
Practice Address - Country:US
Practice Address - Phone:650-726-3355
Practice Address - Fax:650-726-5234
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist