Richard W. Shepherd, D.D.S., P.S.
Individual provider Active NPI General Practice Dentistry · Winlock, WA
NPI 1679772602 · NPPES record last updated Jul 11, 2007
Key facts
- NPI
- 1679772602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DE00004304 (WA)
- Practice address
- 617 Cemetary Rd
Winlock, WA 98596-9303 - Phone
- (360) 785-4755
- Fax
- (360) 785-3336
- NPI assigned
- Jul 11, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00004304 | WA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00004304 | WA | Yes |
Addresses
Primary practice location
617 Cemetary Rd
Winlock, WA 98596-9303
Mailing address
617 Cemetary Rd
Winlock, WA 98596-9303
Phone (360) 785-4755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29532 | Other | WA | L & I |
| 539-3608 | Medicaid | WA |
Other providers in Winlock, WA
- Diane Elizabeth Marines
- Marlee Meyers
- Myocare LLC
- Jason Nelson
- Toni R Schmidt
- Nadya Tahri
- Kimberlee Tilton
- Dorothea Van Arnam
- Howard Wayland Welsh
- Winlock School District
All providers in Winlock, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.