Provider Demographics
NPI:1306299946
Name:NAOMI SEVER, DDS, PLLC
Entity type:Organization
Organization Name:NAOMI SEVER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:STAR
Authorized Official - Last Name:SEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-769-5515
Mailing Address - Street 1:4840 RIVERBEND RD
Mailing Address - Street 2:#200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2659
Mailing Address - Country:US
Mailing Address - Phone:303-440-4777
Mailing Address - Fax:
Practice Address - Street 1:4840 RIVERBEND RD
Practice Address - Street 2:#200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2659
Practice Address - Country:US
Practice Address - Phone:303-440-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty