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General NPI Number Information
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NPI Number | 1508073438
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Entity Type | Individual
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Provider Name | GREGORY D SEGRAVES D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 6132 E 61ST ST
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City | TULSA
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State | OK
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Zip | 74136-2117
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Country | US
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Telephone | 918-494-8634
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Fax | 918-494-8636
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Provider Business Mailing Address
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Address Line | 6132 E 61ST ST
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City | TULSA
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State | OK
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Zip | 74136-2117
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Country | US
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Telephone | 918-494-8636
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Fax | 918-494-8636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5930
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30173
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License Number State | IA
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