Provider Demographics
NPI:1841393261
Name:DEAVER, DON R (DDS)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:R
Last Name:DEAVER
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 1:5756 SOUTH STAPLES
Mailing Address - Street 2:SUITE H
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413
Mailing Address - Country:US
Mailing Address - Phone:361-992-7721
Mailing Address - Fax:361-992-1701
Practice Address - Street 1:5756 SOUTH STAPLES
Practice Address - Street 2:SUITE H
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413
Practice Address - Country:US
Practice Address - Phone:361-992-7721
Practice Address - Fax:361-992-1701
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice