MEDICARE: DR. LOUIS ERVIN SHEPARD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1450	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962460873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS ERVIN SHEPARD DDS

Provider Business Mailing Address
First Line	:	807 S PENDLETON ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3527
Country	:	US
Telephone Number	:	864-859-0111
Fax Number	:	864-859-0112

Provider Business Practice Location Address
First Line	:	807 S PENDLETON ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3527
Country	:	US
Telephone Number	:	864-859-0111
Fax Number	:	864-859-0112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	07/08/2007

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