Provider Demographics
NPI:1477518058
Name:SEVETZ, EDWARD BRUCE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRUCE
Last Name:SEVETZ
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5180
Mailing Address - Country:US
Mailing Address - Phone:904-272-8484
Mailing Address - Fax:904-272-4669
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:SUITE # 7
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5180
Practice Address - Country:US
Practice Address - Phone:904-272-8484
Practice Address - Fax:904-272-4669
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL79601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery