Healthcare Provider Details

I. General information

NPI: 1083749675
Provider Name (Legal Business Name): AARON G SEGAL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST TEMPLE UNIVERSITY SCHOOL OF DENTISTRY
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3223 N BROAD ST TEMPLE UNIVERSITY SCHOOL OF DENTISTRY
PHILADELPHIA PA
19140-5007
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-8185
  • Fax:
Mailing address:
  • Phone: 215-707-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number034745
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS022015L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: