MEDICARE: DR. KHALILAH N SHEPHARD DDS

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	21817	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	737261	OTHER		UNITED CONCORDIA

General Provider Information

NPI Number	:	1649490962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALILAH N SHEPHARD DDS

Provider Business Mailing Address
First Line	:	6130 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3802
Country	:	US
Telephone Number	:	281-499-8340
Fax Number	:	281-499-7496

Provider Business Practice Location Address
First Line	:	6130 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3802
Country	:	US
Telephone Number	:	281-499-8340
Fax Number	:	281-499-7496

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

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	09/01/2022

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