Provider Demographics
NPI:1194349456
Name:SEVERCHENKO, DENYS (DMD)
Entity type:Individual
Prefix:DR
First Name:DENYS
Middle Name:
Last Name:SEVERCHENKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SE 14TH ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1852
Mailing Address - Country:US
Mailing Address - Phone:954-523-6525
Mailing Address - Fax:
Practice Address - Street 1:2401 W BROWARD BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1319
Practice Address - Country:US
Practice Address - Phone:954-824-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist