Individual
DR. JONATHAN ISAK SIVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4700 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 55110-3336
(651) 762-7677
(651) 762-1861
Mailing address
1291 NILES AVE, SAINT PAUL, MN 55116-1632
(612) 360-1713
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12410
MN
Other
Enumeration date
06/12/2007
Last updated
07/08/2007
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