Provider Demographics
NPI:1467494443
Name:SHIVER, RON L (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:L
Last Name:SHIVER
Suffix:
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 1:818 NORTHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1398
Mailing Address - Country:US
Mailing Address - Phone:229-247-0923
Mailing Address - Fax:229-247-7196
Practice Address - Street 1:818 NORTHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1398
Practice Address - Country:US
Practice Address - Phone:229-247-0923
Practice Address - Fax:229-247-7196
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice