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General NPI Number Information
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NPI Number | 1205844081
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Entity Type | Organization
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Legal Business Name | JEFFREY D. SEVENER, D.D.S., P.C.
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1827 W SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49441-3477
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Country | US
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Telephone | 231-755-6515
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Fax | 231-755-9632
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Provider Business Mailing Address
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Address Line | 1827 W SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49441-3477
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Country | US
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Telephone | 231-755-6515
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Fax | 231-755-9632
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DAVID SEVENER
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Credential | D.D.S.
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Telephone | 231-755-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17061
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License Number State | MI
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