Provider Demographics
NPI:1841873262
Name:SHEPHARD, JENEEN RENEE (DDS)
Entity type:Individual
Prefix:
First Name:JENEEN
Middle Name:RENEE
Last Name:SHEPHARD
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 1:630 36TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4100
Mailing Address - Country:US
Mailing Address - Phone:616-538-9020
Mailing Address - Fax:
Practice Address - Street 1:630 36TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4100
Practice Address - Country:US
Practice Address - Phone:616-538-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4913122300000X
MI29016011631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist