Provider Demographics
NPI:1164598777
Name:SEGAL, CRAIG A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DONALD ROSS RD
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1605
Mailing Address - Country:US
Mailing Address - Phone:561-487-4268
Mailing Address - Fax:
Practice Address - Street 1:825 DONALD ROSS RD
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1605
Practice Address - Country:US
Practice Address - Phone:561-630-8668
Practice Address - Fax:561-630-8677
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64617OtherBCBS #
FL163178OtherUNITED CONCORDIA INSURANC