Healthcare Provider Details

I. General information

NPI: 1265501787
Provider Name (Legal Business Name): STEVEN W SEGALL DDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 MONONA DRIVE
MADISON WI
53716-1138
US

IV. Provider business mailing address

4002 MONONA DRIVE
MADISON WI
53716-1138
US

V. Phone/Fax

Practice location:
  • Phone: 608-222-4777
  • Fax: 608-222-2532
Mailing address:
  • Phone: 608-222-4777
  • Fax: 608-222-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5001279015
License Number StateWI

VIII. Authorized Official

Name: DR. STEVEN WALTER SEGALL
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 608-222-4777