Provider Demographics
NPI:1043433147
Name:SEAVERSON, ROY A (DDS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:SEAVERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5626
Mailing Address - Country:US
Mailing Address - Phone:605-336-1388
Mailing Address - Fax:605-332-9216
Practice Address - Street 1:3218 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5626
Practice Address - Country:US
Practice Address - Phone:605-336-1388
Practice Address - Fax:605-332-9216
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNM629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist