Active NPI
Walter Brian Shepherd, DDS MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Eden, NC
National Provider Identifier
1871696427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 014113
- Practice address
- 113 E Moore St
Eden, NC 27289 - Phone
- (336) 627-5163
- Fax
- (336) 627-5165
- NPI assigned
- Sep 7, 2006
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 014113 | NC | Primary |
Addresses
Primary practice location
113 E Moore St
Eden, NC 27289
Mailing address
PO Box 246
Walter Shepherd DDS Ms
Eden, NC 27289
Phone (336) 627-5163
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8997773 | Medicaid | NC | |
| 078247 | Other | VA | BCBS INSURANCE OF VA |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014113 | NC | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walter B. Shepherd | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Eden, NC
- NPI 1295907574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871696427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 246",
"address_2": "WALTER SHEPHERD DDS MS",
"city": "EDEN",
"state": "NC",
"postal_code": "27289",
"telephone_number": "336-627-5163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 E MOORE ST",
"city": "EDEN",
"state": "NC",
"postal_code": "27289",
"telephone_number": "336-627-5163",
"fax_number": "336-627-5165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "WALTER",
"middle_name": "BRIAN",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NC",
"license": "014113",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8997773",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INSURANCE OF VA",
"identifier": "078247",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eden, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.