Provider Demographics
NPI:1134143977
Name:EDWARD H. SEGAL, D.D.S., LTD.
Entity Type:Organization
Organization Name:EDWARD H. SEGAL, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-498-5630
Mailing Address - Street 1:1500 SHERMER RD
Mailing Address - Street 2:SUITE 340W
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5340
Mailing Address - Country:US
Mailing Address - Phone:847-498-5630
Mailing Address - Fax:847-498-8801
Practice Address - Street 1:1500 SHERMER RD
Practice Address - Street 2:SUITE 340W
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5340
Practice Address - Country:US
Practice Address - Phone:847-498-5630
Practice Address - Fax:847-498-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600084871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty