Michael Derae Sheppard, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

21182 Issued in TX

Practice address

2310 FM 157 North
Suite 103
Mansfield, TX 76063

Phone

(817) 477-0922

Fax

(817) 477-0910

NPI assigned

May 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• The Center for Oral, Facial, and Implant Surgery PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Mansfield, TX
  • NPI 1467694208
  NPD (past) Authorized official

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237939200000",
    "number": "1871547893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 FM 157 NORTH",
            "address_2": "SUITE 103",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "817-477-0922",
            "fax_number": "817-477-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 FM 157 NORTH",
            "address_2": "SUITE 103",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "817-477-0922",
            "fax_number": "817-477-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPPARD",
        "first_name": "MICHAEL",
        "middle_name": "DERAE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2009-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "21182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Sheaffer, PA-C
• Munib Sheikh, PHARM.D
• Jacquelyn Conaway Shekarchi, CPNP
• Shepherd Non-Emergency Medical Transportation LLC
• Kylie Lanier Sheppard
• Alicia E Sherin, LMT AND MMP
• Staceyann Wade Shoemake, M.S. CCC-SLP
• Yashoda Shrestha, FNP-C
• Ashfaq H Siddiqui, MD FACS
• Khadija Siddiqui, D.O

• Oral and Maxillofacial Surgery (Dentist) in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; 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.