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General NPI Number Information
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NPI Number | 1013465806
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Entity Type | Individual
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Provider Name | JOHN BRADLEY SHEPHERD DMD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 7260 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89118-4669
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Country | US
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Telephone | 702-896-7211
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Fax |
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Provider Business Mailing Address
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Address Line | 371 TURTLE PEAK AVE
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City | LAS VEGAS
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State | NV
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Zip | 89148-2753
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Country | US
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Telephone | 714-642-5370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6789
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License Number State | NV
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