Healthcare Provider Details

I. General information

NPI: 1851561195
Provider Name (Legal Business Name): RICHARD ALVA SHEPPARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL CENTER DRIVE
CLARENDON TX
79226-0749
US

IV. Provider business mailing address

PO BOX 749
CLARENDON TX
79226-0749
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-5628
  • Fax: 806-874-0402
Mailing address:
  • Phone: 806-874-5628
  • Fax: 806-874-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11534
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: