Provider Demographics
NPI:1942630447
Name:SHIVAR, WALKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALKER
Middle Name:
Last Name:SHIVAR
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 1:302 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:757-583-2333
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:757-583-2333
Practice Address - Fax:757-424-1708
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics