Healthcare Provider Details

I. General information

NPI: 1235349408
Provider Name (Legal Business Name): RINA M. GUDELMAN-SEGALL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 TALMADGE RD STE 100
TOLEDO OH
43623-2168
US

IV. Provider business mailing address

7232 REGENTS PARK BLVD
TOLEDO OH
43617-2247
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-9611
  • Fax:
Mailing address:
  • Phone: 419-843-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: