MEDICARE: JOANN SEGURA D.D.S.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16155	TX

General Provider Information

NPI Number	:	1669746129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANN SEGURA D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	1475 GEORGE DIETER DR.
Second Line	:	SUITE L-1
City	:	EL PASO
State	:	TX
Zip	:	79936-7634
Country	:	US
Telephone Number	:	915-857-1111
Fax Number	:	915-857-1212

Provider Business Practice Location Address
First Line	:	1475 GEORGE DIETER DR
Second Line	:	SUITE L-1
City	:	EL PASO
State	:	TX
Zip	:	79936-7677
Country	:	US
Telephone Number	:	915-857-1111
Fax Number	:	915-857-1212

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOANN SEGURA
Credential	:
Telephone Number	:	915-857-1111

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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