Provider Demographics
NPI:1558762500
Name:SEGALL, COLLEEN ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:SEGALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:113 BURNETT CT
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3100
Mailing Address - Country:US
Mailing Address - Phone:254-224-6008
Mailing Address - Fax:
Practice Address - Street 1:113 BURNETT CT
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3100
Practice Address - Country:US
Practice Address - Phone:254-224-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365251223P0221X
NJ22DI02580800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry