Provider Demographics
NPI:1720029986
Name:SHIVELY, DAVID DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN
Last Name:SHIVELY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 AUBURN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2979
Mailing Address - Country:US
Mailing Address - Phone:661-325-3498
Mailing Address - Fax:
Practice Address - Street 1:304 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-1804
Practice Address - Country:US
Practice Address - Phone:661-325-3498
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice