Provider Demographics
NPI:1699869560
Name:SEEVERS, ROGER DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DEAN
Last Name:SEEVERS
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:PO BOX 1770
Mailing Address - Street 2:326 W FRANKLIN ST
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-1770
Mailing Address - Country:US
Mailing Address - Phone:574-293-5732
Mailing Address - Fax:
Practice Address - Street 1:326 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516
Practice Address - Country:US
Practice Address - Phone:574-293-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007659A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SEE 22455OtherBCBS