Healthcare Provider Details

I. General information

NPI: 1922933563
Provider Name (Legal Business Name): SHEPHERD DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 EL SOBRANTE RD
CORONA CA
92879-5759
US

IV. Provider business mailing address

150 E BIRCH AVE
HANFORD CA
93230-1409
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-5033
  • Fax:
Mailing address:
  • Phone: 805-441-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SLADE SHEPHERD
Title or Position: DENTIST
Credential: DDS,MS
Phone: 805-441-5236