Provider Demographics
NPI:1861479099
Name:SEVERIN, MYREN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYREN
Middle Name:RICHARD
Last Name:SEVERIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY HAWAII ATTN: MCDS-NH
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-1021
Mailing Address - Fax:808-433-3928
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:US ARMY DENTAL ACTIVITY HAWAII ATTN: MCDS-NH
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-1021
Practice Address - Fax:808-433-3928
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19201223G0001X
VA055281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice