Provider Demographics
NPI:1720284029
Name:SHEPARD, CRISTOPHER ALLAN JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRISTOPHER
Middle Name:ALLAN JOSEPH
Last Name:SHEPARD
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 1:1165 COAST VILLAGE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2747
Mailing Address - Country:US
Mailing Address - Phone:805-565-9837
Mailing Address - Fax:
Practice Address - Street 1:1165 COAST VILLAGE RD
Practice Address - Street 2:SUITE I
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2747
Practice Address - Country:US
Practice Address - Phone:805-565-9837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist