Provider Demographics
NPI:1598277717
Name:MARTHA SEVERE DDS LLC
Entity type:Organization
Organization Name:MARTHA SEVERE DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CLAUDE-ELLA
Authorized Official - Last Name:SEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-389-4080
Mailing Address - Street 1:133 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6904
Mailing Address - Country:US
Mailing Address - Phone:917-586-5612
Mailing Address - Fax:
Practice Address - Street 1:133 HUDSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6904
Practice Address - Country:US
Practice Address - Phone:917-586-5612
Practice Address - Fax:917-586-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty