Provider Demographics
NPI:1205844081
Name:JEFFREY D. SEVENER, D.D.S., P.C.
Entity Type:Organization
Organization Name:JEFFREY D. SEVENER, D.D.S., P.C.
Other - Org Name:PINNACLE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SEVENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-755-6515
Mailing Address - Street 1:1827 W SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3477
Mailing Address - Country:US
Mailing Address - Phone:231-755-6515
Mailing Address - Fax:231-755-9632
Practice Address - Street 1:1827 W SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3477
Practice Address - Country:US
Practice Address - Phone:231-755-6515
Practice Address - Fax:231-755-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4435015Medicaid