Provider Demographics
NPI:1548395072
Name:SEVENICH, STEPHEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:SEVENICH
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 1:1339 CAMP RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-5235
Mailing Address - Country:US
Mailing Address - Phone:920-737-7619
Mailing Address - Fax:
Practice Address - Street 1:1339 CAMP RAVINE RD
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:TN
Practice Address - Zip Code:37029-5235
Practice Address - Country:US
Practice Address - Phone:920-737-7619
Practice Address - Fax:920-432-7773
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI32641223G0001X
TN120941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice