NPIMap

Organization Active NPI

Kathleen S. Shepard, D.D.S., Inc.

  • General Practice Dentistry
  • Cincinnati, OH
National Provider Identifier
1639186257
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19505 Issued in OH
Legal business name
KATHLEEN S. SHEPARD, D.D.S., INC.
Practice address
6 Triangle Park Dr
Suite 603
Cincinnati, OH 45246-3403
Phone
(513) 851-0044
Fax
(513) 851-9130
NPI assigned
Aug 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kathleen Suzette Dubose, D.D.S.NPI 1710216197
Title
Ceo/President
Phone
(513) 851-0044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19505 OH Primary

Addresses

Primary practice location

6 Triangle Park Dr
Suite 603
Cincinnati, OH 45246-3403

Mailing address

6 Triangle Park Dr
Suite 603
Cincinnati, OH 45246-3403
Phone (513) 851-0044

Other identifiers 1

IdentifierTypeStateIssuer
0229952MedicaidOH

National Provider Directory

National Provider Directory

Locations

6 Triangle Park Dr
Ste 603
Cincinnati, OH 45246
Phone (513) 851-0044

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639186257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 TRIANGLE PARK DR",
            "address_2": "SUITE 603",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463403",
            "telephone_number": "513-851-0044",
            "fax_number": "513-851-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TRIANGLE PARK DR",
            "address_2": "SUITE 603",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463403",
            "telephone_number": "513-851-0044",
            "fax_number": "513-851-9130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN S. SHEPARD, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUBOSE",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "SUZETTE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "513-851-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0229952",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.