Provider Demographics
NPI:1942239710
Name:SHIVERS, RODNEY ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ERIC
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 1:13509 N MERIDIAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8396
Mailing Address - Country:US
Mailing Address - Phone:405-755-4099
Mailing Address - Fax:405-755-4662
Practice Address - Street 1:13509 N MERIDIAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8396
Practice Address - Country:US
Practice Address - Phone:405-755-4099
Practice Address - Fax:405-755-4662
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice