Provider Demographics
NPI:1942565213
Name:NIVER, KRYSTIE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRYSTIE
Middle Name:M
Last Name:NIVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRYSTIE
Other - Middle Name:M
Other - Last Name:NIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:236 CARMICHAEL WAY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2185
Mailing Address - Country:US
Mailing Address - Phone:757-932-5200
Mailing Address - Fax:757-257-9548
Practice Address - Street 1:236 CARMICHAEL WAY
Practice Address - Street 2:SUITE # 312
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2185
Practice Address - Country:US
Practice Address - Phone:757-932-5200
Practice Address - Fax:757-257-9548
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice