Provider Demographics
NPI:1538807565
Name:SHEPHERD, TAYLOR MARIE (DMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 GROVER RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-9004
Mailing Address - Country:US
Mailing Address - Phone:513-939-4366
Mailing Address - Fax:
Practice Address - Street 1:110 S TIPPECANOE DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-3104
Practice Address - Country:US
Practice Address - Phone:937-226-9427
Practice Address - Fax:937-977-1755
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist