MEDICARE: DR. GREGORY BRIAN SHEPPARD D.D.S.

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	1223P0221X	Pediatric Dentistry	D7220	AZ

General Provider Information

NPI Number	:	1396937231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY BRIAN SHEPPARD D.D.S.

Provider Business Mailing Address
First Line	:	3618 W ANTHEM WAY STE D104
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0458
Country	:	US
Telephone Number	:	623-551-3391
Fax Number	:	623-551-8959

Provider Business Practice Location Address
First Line	:	3618 W ANTHEM WAY STE D104
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0458
Country	:	US
Telephone Number	:	623-551-3391
Fax Number	:	623-551-8959

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	09/08/2008

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