Provider Demographics
NPI:1902219827
Name:SEVERE, DAVID LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANE
Last Name:SEVERE
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 1:7109 AFTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918
Mailing Address - Country:US
Mailing Address - Phone:865-922-2101
Mailing Address - Fax:
Practice Address - Street 1:7109 AFTON DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918
Practice Address - Country:US
Practice Address - Phone:865-922-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30030122300000X
TN11131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist