Provider Demographics
NPI:1427533637
Name:PAUL K SHIVERS DDS
Entity type:Organization
Organization Name:PAUL K SHIVERS DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-332-9422
Mailing Address - Street 1:2951 ST RT 45 S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9465
Mailing Address - Country:US
Mailing Address - Phone:330-332-9422
Mailing Address - Fax:
Practice Address - Street 1:2951 ST RT 45 S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9465
Practice Address - Country:US
Practice Address - Phone:330-332-9422
Practice Address - Fax:330-332-0155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIVERS DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495003Medicaid