Healthcare Provider Details

I. General information

NPI: 1063072981
Provider Name (Legal Business Name): JULIA REGINA SEGAL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 ORANGE PL STE 455
BEACHWOOD OH
44122-4438
US

IV. Provider business mailing address

3690 ORANGE PL STE 455
BEACHWOOD OH
44122-4438
US

V. Phone/Fax

Practice location:
  • Phone: 216-360-0090
  • Fax:
Mailing address:
  • Phone: 216-360-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30.027420
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042587
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: