Individual
WALTER BRIAN SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
113 E MOORE ST, EDEN, NC 27289
(336) 627-5163
(336) 627-5165
Mailing address
PO BOX 246, WALTER SHEPHERD DDS MS, EDEN, NC 27289
(336) 627-5163
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
014113
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078247
BCBS INSURANCE OF VA
VA
05
—
8997773
—
NC
Enumeration date
09/07/2006
Last updated
07/08/2007
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