Provider Demographics
NPI:1811738420
Name:SEVERSON, JUDE JEROME (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDE
Middle Name:JEROME
Last Name:SEVERSON
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 1:21466 ARCHIBALD RD
Mailing Address - Street 2:
Mailing Address - City:DEERWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56444-4100
Mailing Address - Country:US
Mailing Address - Phone:218-821-0534
Mailing Address - Fax:
Practice Address - Street 1:1050 MINNESOTA AVE S
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-7412
Practice Address - Country:US
Practice Address - Phone:218-927-3785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice