MEDICARE: JOHN BRADLEY SHEPHERD DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6789	NV

General Provider Information

NPI Number	:	1013465806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRADLEY SHEPHERD DMD

Provider Business Mailing Address
First Line	:	371 TURTLE PEAK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2753
Country	:	US
Telephone Number	:	714-642-5370
Fax Number	:

Provider Business Practice Location Address
First Line	:	7260 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4669
Country	:	US
Telephone Number	:	702-896-7211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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