Individual
MR. GRADY D SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
73265 CONFEDERATED WAY, PENDLETON, OR 97801-0160
(541) 966-9830
(541) 278-7590
Mailing address
PO BOX 160, PENDLETON, OR 97801-0160
(541) 966-9830
(541) 278-7590
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9825
OR
122300000X
Dentist
DE60114016
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500653068
—
OR
Enumeration date
09/21/2009
Last updated
03/09/2016
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