Provider Demographics
NPI:1700321056
Name:SHREVE, JOHN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:SHREVE
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 1:109 HCC BLVD.
Mailing Address - Street 2:
Mailing Address - City:HUTTONSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26273
Mailing Address - Country:US
Mailing Address - Phone:304-335-2291
Mailing Address - Fax:
Practice Address - Street 1:109 HCC BLVD
Practice Address - Street 2:
Practice Address - City:HUTTONSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26273
Practice Address - Country:US
Practice Address - Phone:304-335-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice