Provider Demographics
NPI:1184953192
Name:SEVENER, JEFFREY D (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:SEVENER
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 1:1827 W SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3477
Mailing Address - Country:US
Mailing Address - Phone:231-755-6515
Mailing Address - Fax:231-755-9632
Practice Address - Street 1:1827 W SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3477
Practice Address - Country:US
Practice Address - Phone:231-755-6515
Practice Address - Fax:231-755-9632
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice