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General NPI Number Information
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NPI Number | 1124426788
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Entity Type | Organization
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Legal Business Name | J SCOTT SHEPHERD DMD INC
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 2150 E TAHQUITZ CANYON WAY SUITE #2
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7045
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Country | US
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Telephone | 760-416-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 E TAHQUITZ CANYON WAY SUITE #2
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7045
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Country | US
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Telephone | 760-416-1003
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY SCOTT SHEPHERD
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Credential | DMD
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Telephone | 760-808-1554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 51451
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License Number State | CA
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