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General NPI Number Information
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NPI Number | 1629395900
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Entity Type | Organization
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Legal Business Name | SHEPHERD DENTAL PC
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 235 E HILDEBRAND AVE STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2430
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Country | US
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Telephone | 210-820-0400
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Fax | 210-820-0042
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Provider Business Mailing Address
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Address Line | 235 E HILDEBRAND AVE STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2430
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Country | US
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Telephone | 210-820-0400
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Fax | 210-820-0042
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Authorized Official
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Title or Position | OWNER
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Name | DR. JO ANN YBARRA SHEPHERD
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Credential | D.D.S.
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Telephone | 210-820-0400
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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 | 13395
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License Number State | TX
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