Provider Demographics
NPI:1811983463
Name:SHEPPARD, KIMBERLY DAWN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1449
Mailing Address - Country:US
Mailing Address - Phone:630-969-5006
Mailing Address - Fax:
Practice Address - Street 1:990 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1739
Practice Address - Country:US
Practice Address - Phone:847-885-1664
Practice Address - Fax:847-885-1705
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics