Individual
DR. JEREMIAH JOSEPH SHIPLOV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1067 TWINING DR, BERKSDALE AFB, LA 71110-2414
(318) 456-6776
(318) 456-6636
Mailing address
231 OCKLEY DR, SHREVEPORT, LA 71105-3024
(318) 869-4102
(318) 456-6776
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4227
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21648
STATE DRUG DEPT OF HEALTH
LA
Enumeration date
03/16/2006
Last updated
03/07/2023
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