Provider Demographics
NPI:1063863496
Name:SEGAL, SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 SW DURHAM DR
Mailing Address - Street 2:APT 301
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3786
Mailing Address - Country:US
Mailing Address - Phone:704-258-3325
Mailing Address - Fax:
Practice Address - Street 1:15 RAWLS RD
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-6033
Practice Address - Country:US
Practice Address - Phone:919-586-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist