MEDICARE: MC KAID SHEPPARD 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	21465	MT

General Provider Information

NPI Number	:	1750904991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MC KAID SHEPPARD DDS

Provider Business Mailing Address
First Line	:	4401 BLUE DEVILS WAY APT 3
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-3721
Country	:	US
Telephone Number	:	208-339-4394
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 GRAND AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-3302
Country	:	US
Telephone Number	:	406-625-3000
Fax Number	:

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

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	08/30/2021

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Directions to “ MC KAID SHEPPARD DDS” Practice Location

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