Provider Demographics
NPI:1831284603
Name:SEGHERS, DAVID TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:SEGHERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 HERITAGE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5987
Mailing Address - Country:US
Mailing Address - Phone:817-283-4444
Mailing Address - Fax:817-283-0771
Practice Address - Street 1:5209 HERITAGE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5987
Practice Address - Country:US
Practice Address - Phone:817-283-4444
Practice Address - Fax:817-283-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice