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NPI Code Detail

MEDICARE: KIESHA SHEPARD

MEDICARE: KIESHA SHEPARD
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
11223G0001XGeneral Practice Dentistry20339TX

General Provider Information

NPI Number : 1962563817
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIESHA SHEPARD
Provider Business Mailing Address
First Line : 3701 KIRBY DR
Second Line : SUITE 550
City : HOUSTON
State : TX
Zip : 77098-3900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2321 BAY AREA BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77058-2009
Country : US
Telephone Number : 281-480-9870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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Directions to “ KIESHA SHEPARD ” Practice Location

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