Provider Demographics
NPI:1235202748
Name:SEAVERSON, JOHN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
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 1:1401 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343
Mailing Address - Country:US
Mailing Address - Phone:952-475-1101
Mailing Address - Fax:952-448-6856
Practice Address - Street 1:1401 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:952-448-4151
Practice Address - Fax:952-448-6856
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice