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General NPI Number Information
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NPI Number | 1851643415
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Entity Type | Organization
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Legal Business Name | SEGELNICK SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 5481 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4643
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Country | US
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Telephone | 954-575-5488
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Fax |
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Provider Business Mailing Address
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Address Line | 5481 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4643
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW SEGELNICK
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Credential | D.M.D
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Telephone | 954-609-5681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN15865
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License Number State | FL
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