Healthcare Provider Details

I. General information

NPI: 1326120411
Provider Name (Legal Business Name): ROBERT ROLAND SEGHI DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE DENTAL FACULTY PRACTICE ASSOCIATION INC.
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE DENTAL FACULTY PRACTICE ASSOCIATION INC.
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-1472
  • Fax:
Mailing address:
  • Phone: 614-292-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30-19658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: