Provider Demographics
NPI:1902926702
Name:SHEPARD, LILIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILIANE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LILIANE
Other - Middle Name:
Other - Last Name:BOABAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3211 BUSINESS PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8259
Mailing Address - Country:US
Mailing Address - Phone:760-727-6800
Mailing Address - Fax:760-727-4225
Practice Address - Street 1:3211 BUSINESS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8259
Practice Address - Country:US
Practice Address - Phone:760-727-6800
Practice Address - Fax:760-727-4225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist