Provider Demographics
NPI:1215083746
Name:SHEPPERD, STEVEN (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SHEPPERD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 WOODSTOCK RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8220
Mailing Address - Country:US
Mailing Address - Phone:770-649-0606
Mailing Address - Fax:770-649-6395
Practice Address - Street 1:1125 WOODSTOCK RD
Practice Address - Street 2:SUITE 520
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8220
Practice Address - Country:US
Practice Address - Phone:770-649-0606
Practice Address - Fax:770-649-6395
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice