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Organization

WALTER B. SHEPHERD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WALTER B SHEPHERD DDS MS PA (ORTHODONTIST/OWNER)
(336) 627-5163
Entity
Organization

Contact information

Practice address
113 E MOORE ST, EDEN, NC 27288
(336) 627-5163
(336) 627-5165
Mailing address
PO BOX 246, EDEN, NC 27289-0246
(336) 627-5163
(336) 627-5165

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
004113
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
078247
VIRGINIA BCBS
VA
05
8997773
NC
Enumeration date
03/27/2008
Last updated
03/27/2008
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