Provider Demographics
NPI:1699943159
Name:SHEPHERD, JOHN T (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
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 1:1108 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-3030
Mailing Address - Country:US
Mailing Address - Phone:979-541-5400
Mailing Address - Fax:
Practice Address - Street 1:1108 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-3030
Practice Address - Country:US
Practice Address - Phone:979-541-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist