Healthcare Provider Details

I. General information

NPI: 1093842320
Provider Name (Legal Business Name): BRUCE ELWOOD SHAVER DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HOSPITAL DRIVE SUITE E
WARNER ROBINS GA
31088
US

IV. Provider business mailing address

212 HOSPITAL DRIVE SUITE E
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-2464
  • Fax: 478-923-0363
Mailing address:
  • Phone: 478-923-2464
  • Fax: 478-923-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10173
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: