Provider Demographics
NPI:1710415294
Name:MARIA CLAUDIA SEGRERA PA
Entity Type:Organization
Organization Name:MARIA CLAUDIA SEGRERA PA
Other - Org Name:DENTAL CLINIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-228-6661
Mailing Address - Street 1:16636 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4128
Mailing Address - Country:US
Mailing Address - Phone:954-228-6661
Mailing Address - Fax:
Practice Address - Street 1:16636 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33331-4128
Practice Address - Country:US
Practice Address - Phone:954-228-6661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental