Provider Demographics
NPI:1720305741
Name:SHEPHERD, CASEY RUSSELL (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:RUSSELL
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DMD MD
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Mailing Address - Street 1:180 TIMBERWOLF PKWY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1218
Mailing Address - Country:US
Mailing Address - Phone:406-755-6014
Mailing Address - Fax:406-755-6094
Practice Address - Street 1:180 TIMBERWOLF PKWY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1218
Practice Address - Country:US
Practice Address - Phone:406-755-6014
Practice Address - Fax:406-755-6094
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT115021223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery