Provider Demographics
NPI:1467449751
Name:SEGAL, EDWARD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics