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General NPI Number Information
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NPI Number | 1093049306
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Entity Type | Individual
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Provider Name | GRADY D SHAVER DMD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 73265 CONFEDERATED WAY
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City | PENDLETON
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State | OR
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Zip | 97801-0160
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Country | US
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Telephone | 541-966-9830
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Fax | 541-278-7590
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | PENDLETON
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State | OR
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Zip | 97801-0160
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Country | US
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Telephone | 541-966-9830
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Fax | 541-278-7590
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60114016
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9825
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License Number State | OR
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