Keith E Shepard, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN014208 Issued in GA

Practice address

705 Windy Hill Rd SE
Smyrna, GA 30080-1854

Phone

(770) 801-1641

Fax

(770) 801-0587

NPI assigned

May 25, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Houston County Health Department

  • State or Local Public Health Clinic/Center
  • Macon, GA
  • NPI 1689631715

  GA

  Medicare reassignment NPD
• Crawford County Health Department

  • State or Local Public Health Clinic/Center
  • Roberta, GA
  • NPI 1679583686
  NPD
• Houston County Health Department

  • Community/Retail Pharmacy
  • Macon, GA
  • NPI 1700360831
  NPD
• Jones County Health Department

  • Public Health or Welfare Agency
  • Gray, GA
  • NPI 1861403586
  NPD
• Macon-Bibb County Health Department

  • Public Health or Welfare Agency
  • Macon, GA
  • NPI 1164464756
  NPD
• Twiggs Department of Public Health

  • Public Health or Welfare Agency
  • Jeffersonville, GA
  • NPI 1306853908
  NPD
• Washington County Board of Health

  • Public Health or Welfare Agency
  • Sandersville, GA
  • NPI 1124038096
  NPD
• Theodis Elzie, D.D.S., P.C.

  • Dentist
  • Smyrna, GA
  • NPI 1780993840
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1386855880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 WINDY HILL RD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300801854",
            "telephone_number": "770-801-1641",
            "fax_number": "770-801-0587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 WINDY HILL RD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300801854",
            "telephone_number": "770-801-1641",
            "fax_number": "770-801-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "KEITH",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003122728B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Shaw
• Shereka S Shaw, LPC
• Kelsey Oakley Shea, PMHNP
• Anthony Michael Shearin, DDS
• David Shelton, LMFT
• Ateer K Sheth, MS, CNLM
• Marsha Shewanown, LCSW
• Sung Shim, DMD
• Jiyo Shin, M.D.
• Denise Shipman, MD

• All providers in Smyrna, GA
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.