=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043485741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANDALL SEGNAR DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4608 S HARVARD AVE STE B
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-4621
-----------------------------------------------------
Fax | 918-749-4623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4608 S HARVARD AVE STE B
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-4621
-----------------------------------------------------
Fax | 918-749-4623
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. RANDALL RICHARD SEGNAR
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 918-749-4621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5441
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------