Provider Demographics
NPI:1699706218
Name:SHEPHERD, THOMAS JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
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 1:14435 N. CHESHIRE ST.
Mailing Address - Street 2:P.O.BOX 477
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-0477
Mailing Address - Country:US
Mailing Address - Phone:440-834-1239
Mailing Address - Fax:440-834-1239
Practice Address - Street 1:14435 N. CHESHIRE ST.
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-0477
Practice Address - Country:US
Practice Address - Phone:440-834-1239
Practice Address - Fax:440-834-1239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291625Medicaid