Provider Demographics
NPI:1427148840
Name:SHEPHERD, WILLIAM DANIEL (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANIEL
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:DAN
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:LL102 BLDG B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3663
Mailing Address - Fax:270-683-6165
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:LL102 BLDG B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3663
Practice Address - Fax:270-683-6165
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60040243Medicaid