Provider Demographics
NPI:1366449407
Name:SHIVER, STEPHEN WATSON SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WATSON
Last Name:SHIVER
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E. MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-2275
Mailing Address - Country:US
Mailing Address - Phone:229-686-7451
Mailing Address - Fax:229-686-7547
Practice Address - Street 1:410 E. MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2275
Practice Address - Country:US
Practice Address - Phone:229-686-7451
Practice Address - Fax:229-686-7547
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice