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General NPI Number Information
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NPI Number | 1770535544
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Entity Type | Individual
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Provider Name | DAVID K SEVERSON DDS
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 1040 TRUMP RD NW
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City | CARROLLTON
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State | OH
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Zip | 44615-9472
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Country | US
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Telephone | 218-831-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 TRUMP RD NW P.O. BOX297
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City | CARROLLTON
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State | OH
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Zip | 44615-9472
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Country | US
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Telephone | 218-831-3674
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Fax |
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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 | 5772-015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 30.023400
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.023400
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License Number State | OH
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