Active NPI
Stephen Robert Shepherd, D.D.S.
- Periodontics
- Tustin, CA
National Provider Identifier
1487630992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 31706
- Practice address
- 12569 Newport Ave
Tustin, CA 92780-2420 - Phone
- (714) 544-2220
- Fax
- (714) 544-2701
- NPI assigned
- Dec 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 31706 | CA | Primary |
Addresses
Primary practice location
12569 Newport Ave
Tustin, CA 92780-2420
Mailing address
12569 Newport Ave
Tustin, CA 92780-2420
Phone (714) 544-2220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160310001933 | CA | Order and Referring Only - Oral Surgery | 5193021582 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1487630992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12569 NEWPORT AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802420",
"telephone_number": "714-544-2220",
"fax_number": "714-544-2701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12569 NEWPORT AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802420",
"telephone_number": "714-544-2220",
"fax_number": "714-544-2701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "STEPHEN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-16",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "31706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.