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General NPI Number Information
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NPI Number | 1558762500
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Entity Type | Individual
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Provider Name | COLLEEN ELIZABETH SEGALL DMD
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Gender | Female
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 6102 82ND ST STE 2
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City | LUBBOCK
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State | TX
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Zip | 79424-0803
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Country | US
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Telephone | 254-224-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 6102 82ND ST STE 2
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City | LUBBOCK
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State | TX
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Zip | 79424-0803
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Country | US
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Telephone | 806-792-2288
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02580800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 36525
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License Number State | TX
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