Provider Demographics
NPI:1306080353
Name:SHEPHERD, ADAM NICHOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:NICHOLAS
Last Name:SHEPHERD
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 1:1002 S 300 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3881
Mailing Address - Country:US
Mailing Address - Phone:716-868-5823
Mailing Address - Fax:
Practice Address - Street 1:167 N 400 W
Practice Address - Street 2:SUITE A-4
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:801-434-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80123191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry