Healthcare Provider Details

I. General information

NPI: 1588528954
Provider Name (Legal Business Name): TERRI SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 7TH ST NE TRLR 70
GREAT FALLS MT
59404-1152
US

IV. Provider business mailing address

3805 7TH ST NE TRLR 70
GREAT FALLS MT
59404-1152
US

V. Phone/Fax

Practice location:
  • Phone: 406-561-0102
  • Fax:
Mailing address:
  • Phone: 406-561-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number$$$$$$$$$
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: