Provider Demographics
NPI:1730309089
Name:SEGAL, EDITH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:M
Last Name:SEGAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LITTLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3010
Mailing Address - Country:US
Mailing Address - Phone:617-964-1780
Mailing Address - Fax:
Practice Address - Street 1:258 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-4964
Practice Address - Country:US
Practice Address - Phone:781-237-7400
Practice Address - Fax:781-237-7416
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics