Provider Demographics
NPI:1992277883
Name:SCOTT A SHEPPARD, DDS, PLLC
Entity type:Organization
Organization Name:SCOTT A SHEPPARD, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-678-8745
Mailing Address - Street 1:4206 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8331
Mailing Address - Country:US
Mailing Address - Phone:580-355-3065
Mailing Address - Fax:580-355-3084
Practice Address - Street 1:4206 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8331
Practice Address - Country:US
Practice Address - Phone:580-355-3065
Practice Address - Fax:580-355-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty