Provider Demographics
NPI:1063784825
Name:NENI SHRIVER,DDS INC
Entity type:Organization
Organization Name:NENI SHRIVER,DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NENI
Authorized Official - Middle Name:DIAH
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-456-4442
Mailing Address - Street 1:7817 IVANHOE AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4559
Mailing Address - Country:US
Mailing Address - Phone:858-456-4442
Mailing Address - Fax:858-456-4443
Practice Address - Street 1:7817 IVANHOE AVE
Practice Address - Street 2:STE 304
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4559
Practice Address - Country:US
Practice Address - Phone:858-456-4442
Practice Address - Fax:858-456-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty