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General NPI Number Information
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NPI Number | 1578153540
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Entity Type | Organization
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Legal Business Name | WILLIAM T SHEPHERD, JR DDS
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 1242 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-7109
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Country | US
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Telephone | 870-535-0301
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Fax | 870-535-5724
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Provider Business Mailing Address
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Address Line | 1242 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-7109
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Country | US
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Telephone | 870-535-0301
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Fax | 870-535-5724
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Authorized Official
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Title or Position | DDS
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Name | DR. WILLIAM TOLER SHEPHERD JR.
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Credential |
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Telephone | 870-535-0301
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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 |
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License Number State |
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