Provider Demographics
NPI:1033256672
Name:SHRIVER, NENI DIAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NENI
Middle Name:DIAH
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 IVANHOE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4555
Mailing Address - Country:US
Mailing Address - Phone:858-456-4442
Mailing Address - Fax:858-456-4443
Practice Address - Street 1:7817 IVANHOE AVE STE 304
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4555
Practice Address - Country:US
Practice Address - Phone:858-456-4442
Practice Address - Fax:858-456-4443
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice