Provider Demographics
NPI:1265646418
Name:SEGALL, ERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SEGALL
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 1:186 W VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3410
Mailing Address - Country:US
Mailing Address - Phone:732-942-8400
Mailing Address - Fax:732-942-6505
Practice Address - Street 1:186 W VETERANS HWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3410
Practice Address - Country:US
Practice Address - Phone:732-942-8400
Practice Address - Fax:732-942-6505
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics