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General NPI Number Information
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NPI Number | 1295907574
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Entity Type | Organization
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Legal Business Name | WALTER B. SHEPHERD
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 113 E MOORE ST
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City | EDEN
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State | NC
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Zip | 27288
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Country | US
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Telephone | 336-627-5163
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Fax | 336-627-5165
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | EDEN
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State | NC
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Zip | 27289-0246
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Country | US
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Telephone | 336-627-5163
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Fax | 336-627-5165
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Authorized Official
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Title or Position | ORTHODONTIST/OWNER
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Name | DR. WALTER B SHEPHERD
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Credential | DDS MS PA
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Telephone | 336-627-5163
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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 | 004113
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License Number State | NC
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