Provider Demographics
NPI:1659231108
Name:SHEPHERD, LISA CHRISTINE (RDH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:SHEPHERD
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 1:6026 REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-8419
Mailing Address - Country:US
Mailing Address - Phone:620-786-5694
Mailing Address - Fax:
Practice Address - Street 1:1203 W HAROLD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7851
Practice Address - Country:US
Practice Address - Phone:913-229-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10991124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist