Provider Demographics
NPI:1932838265
Name:SHEPPARD, SUSAN JONES (RDH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JONES
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 COBBLESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3208
Mailing Address - Country:US
Mailing Address - Phone:865-591-5182
Mailing Address - Fax:
Practice Address - Street 1:323 S CONCORD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3304
Practice Address - Country:US
Practice Address - Phone:865-637-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4575124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist