Healthcare Provider Details

I. General information

NPI: 1699706218
Provider Name (Legal Business Name): THOMAS JAMES SHEPHERD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14435 N. CHESHIRE ST.
BURTON OH
44021-0477
US

IV. Provider business mailing address

14435 N. CHESHIRE ST. P.O.BOX 477
BURTON OH
44021-0477
US

V. Phone/Fax

Practice location:
  • Phone: 440-834-1239
  • Fax: 440-834-1239
Mailing address:
  • Phone: 440-834-1239
  • Fax: 440-834-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: