Provider Demographics
NPI:1700875077
Name:SHEPARD, CLAYTON ROLAND (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:ROLAND
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7038
Mailing Address - Country:US
Mailing Address - Phone:406-609-9996
Mailing Address - Fax:
Practice Address - Street 1:1315 US HIGHWAY 2 W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3413
Practice Address - Country:US
Practice Address - Phone:406-890-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10035MN1223G0001X
MTDEN-DEN-LIC-244801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDEN-DEN-LIC-24480OtherDENTAL LICENSE NUMBER
MN10035MNOtherDENTAL LICENSE NUMBER
BS0780785OtherDEA NUMBER