Provider Demographics
NPI:1093842320
Name:SHAVER, BRUCE ELWOOD (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ELWOOD
Last Name:SHAVER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-923-2464
Mailing Address - Fax:478-923-0363
Practice Address - Street 1:212 HOSPITAL DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-923-2464
Practice Address - Fax:478-923-0363
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist