Provider Demographics
NPI:1881650406
Name:SHIVERS, PAUL KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KEVIN
Last Name:SHIVERS
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 1:2951 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460
Mailing Address - Country:US
Mailing Address - Phone:330-332-9422
Mailing Address - Fax:330-332-0155
Practice Address - Street 1:2951 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:330-332-9422
Practice Address - Fax:330-332-0155
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495003Medicaid