MEDICARE: CHARLES EDWARD SEGLER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN8262	FL

General Provider Information

NPI Number	:	1871626127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES EDWARD SEGLER D.D.S.

Provider Business Mailing Address
First Line	:	2915 S FEDERAL HWY
Second Line	:	SUITE D-1 DUMAR PLAZA
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3288
Country	:	US
Telephone Number	:	561-278-6008
Fax Number	:	561-278-5522

Provider Business Practice Location Address
First Line	:	2915 S FEDERAL HWY
Second Line	:	SUITE D-1 DUMAR PLAZA
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3288
Country	:	US
Telephone Number	:	561-278-6008
Fax Number	:	561-278-5522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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