Provider Demographics
NPI:1760694921
Name:WALKER W. SHIVAR, D.D.S. ANTHONY R. PELUSO, D.D.S. HOLLY H. ANDERSEN,
Entity Type:Organization
Organization Name:WALKER W. SHIVAR, D.D.S. ANTHONY R. PELUSO, D.D.S. HOLLY H. ANDERSEN,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIRCHEVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-420-4035
Mailing Address - Street 1:302 E LITTLE CREEK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2603
Mailing Address - Country:US
Mailing Address - Phone:757-424-5308
Mailing Address - Fax:757-424-1708
Practice Address - Street 1:302 E LITTLE CREEK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2603
Practice Address - Country:US
Practice Address - Phone:757-424-5308
Practice Address - Fax:757-424-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA54261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty