Shepard, Clayton Roland

Shepard, Clayton Roland is an sole proprietor health care provider with primary practice located at 3911 Coon Rapids Blvd Nw , Coon Rapids MN 55433-2520. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Shepard, Clayton Roland can be contacted via phone (763) 421-0770.

Contact Information

Primary practice address
3911 Coon Rapids Blvd Nw Coon Rapids MN 55433-2520
Phone: (763) 421-0770
Fax: (763) 421-0772
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 10035MN Minnesota

Profile Details

NPI number 1700875077
LBN Legal business name Shepard, Clayton Roland
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 19th, 2005
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700875077 NPPES
Minnesota Other 320022100 MEDICAL ASSISTANCE N UMBE
Minnesota Other 10035MN MEDICAL ASSISTANCE N UMBE

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