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General NPI Number Information
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NPI Number | 1700875077
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Entity Type | Individual
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Provider Name | CLAYTON ROLAND SHEPARD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 1315 US HIGHWAY 2 W
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City | KALISPELL
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State | MT
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Zip | 59901-3413
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Country | US
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Telephone | 406-890-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 CHURCH DR
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City | KALISPELL
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State | MT
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Zip | 59901-7038
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Country | US
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Telephone | 406-609-9996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10035MN
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License Number State | MN
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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 | DEN-DEN-LIC-24480
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License Number State | MT
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