Provider Demographics
NPI:1396937231
Name:SHEPPARD, GREGORY BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRIAN
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3618 W ANTHEM WAY STE D104
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0458
Mailing Address - Country:US
Mailing Address - Phone:623-551-3391
Mailing Address - Fax:623-551-8959
Practice Address - Street 1:3618 W ANTHEM WAY STE D104
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0458
Practice Address - Country:US
Practice Address - Phone:623-551-3391
Practice Address - Fax:623-551-8959
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD72201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry