Provider Demographics
NPI:1598198392
Name:JOHN RUSSELL NIVER, DDS
Entity Type:Organization
Organization Name:JOHN RUSSELL NIVER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:NIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-266-3801
Mailing Address - Street 1:2400 SW 29TH ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1794
Mailing Address - Country:US
Mailing Address - Phone:785-266-3801
Mailing Address - Fax:
Practice Address - Street 1:2400 SW 29TH ST
Practice Address - Street 2:SUITE 226
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1794
Practice Address - Country:US
Practice Address - Phone:785-266-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty