Individual
DR. CASEY RUSSELL SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
180 TIMBERWOLF PKWY, KALISPELL, MT 59901-1218
(406) 755-6014
(406) 755-6094
Mailing address
180 TIMBERWOLF PKWY, KALISPELL, MT 59901-1218
(406) 755-6014
(406) 755-6094
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
11502
MT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
11502
MT
Other
Enumeration date
04/30/2010
Last updated
08/10/2021
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