Active NPI
Crystal Mae Shepherd, RDH
- Dental Hygienist
- Pueblo, CO
National Provider Identifier
1538550728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 002023652
- Practice address
- 3165 E Spaulding Ave Apt 101
Pueblo, CO 81008-2243 - Phone
- (307) 399-6186
- NPI assigned
- Feb 10, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 002023652 | CO | Primary |
Addresses
Primary practice location
3165 E Spaulding Ave Apt 101
Pueblo, CO 81008-2243
Mailing address
3165 E. Spauilding Ave Apt 101
Pueblo, CO 81008
Phone (307) 399-6186
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002023652 | CO | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423526400000",
"number": "1538550728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3165 E. SPAUILDING AVE APT 101",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81008",
"telephone_number": "307-399-6186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3165 E SPAULDING AVE APT 101",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082243",
"telephone_number": "307-399-6186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "CRYSTAL",
"middle_name": "MAE",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-10",
"last_updated": "2015-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CO",
"license": "002023652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.