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General NPI Number Information
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NPI Number | 1316757289
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Entity Type | Organization
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Legal Business Name | SEGOVIA ORTHODONTICS AT LAKEWOOD RANCH
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 5803 BRADEN RUN
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9402
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Country | US
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Telephone | 941-557-1333
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Fax | 941-557-1311
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Provider Business Mailing Address
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Address Line | 5803 BRADEN RUN
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9402
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Country | US
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Telephone | 941-557-1333
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Fax | 941-557-1311
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Authorized Official
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Title or Position | OWNER
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Name | FLOR SEGOVIA
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Credential | DDS
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Telephone | 941-557-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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