MEDICARE: DR. DAVID K SEVERSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5772-015	WI
2	332B00000X	Durable Medical Equipment & Medical Supplies	30.023400	OH
3	122300000X	Dentist	30.023400	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770535544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID K SEVERSON DDS

Provider Business Mailing Address
First Line	:	1040 TRUMP RD NW
Second Line	:	P.O. BOX297
City	:	CARROLLTON
State	:	OH
Zip	:	44615-9472
Country	:	US
Telephone Number	:	218-831-3674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 TRUMP RD NW
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-9472
Country	:	US
Telephone Number	:	218-831-3674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/21/2019

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Directions to “ DR. DAVID K SEVERSON DDS” Practice Location

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