Provider Demographics
NPI:1811501687
Name:KARI L SEAVERSON DDS LLC DBA TOOTH BY THE LAKE
Entity type:Organization
Organization Name:KARI L SEAVERSON DDS LLC DBA TOOTH BY THE LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEAVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-250-5697
Mailing Address - Street 1:1401 MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7404
Mailing Address - Country:US
Mailing Address - Phone:952-475-1101
Mailing Address - Fax:
Practice Address - Street 1:1401 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7404
Practice Address - Country:US
Practice Address - Phone:952-475-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty