Provider Demographics
NPI:1548294804
Name:SHEPHERD, LAURIE E (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:E
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2815
Mailing Address - Country:US
Mailing Address - Phone:510-339-1045
Mailing Address - Fax:510-339-4467
Practice Address - Street 1:2087 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2815
Practice Address - Country:US
Practice Address - Phone:510-339-1045
Practice Address - Fax:510-339-4467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist