Provider Demographics
NPI:1265501787
Name:STEVEN W SEGALL DDS SC
Entity Type:Organization
Organization Name:STEVEN W SEGALL DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:608-222-4777
Mailing Address - Street 1:4002 MONONA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1138
Mailing Address - Country:US
Mailing Address - Phone:608-222-4777
Mailing Address - Fax:608-222-2532
Practice Address - Street 1:4002 MONONA DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1138
Practice Address - Country:US
Practice Address - Phone:608-222-4777
Practice Address - Fax:608-222-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50012790151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty