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General NPI Number Information
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NPI Number | 1114215985
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Entity Type | Organization
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Legal Business Name | SHEPHERD LANE DENTAL ASSOCIATES #2
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 107 S 1ST ST
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City | GARLAND
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State | TX
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Zip | 75040-7219
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Country | US
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Telephone | 972-512-0285
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Fax | 972-239-0755
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Provider Business Mailing Address
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Address Line | 107 S 1ST ST
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City | GARLAND
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State | TX
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Zip | 75040-7219
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Country | US
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Telephone | 972-512-0285
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Fax | 972-239-0755
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HOLLAND MORRISON
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Credential | DDS
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Telephone | 972-512-0285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22654
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22654
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License Number State | TX
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