Provider Demographics
NPI:1861497513
Name:SEGELNICK, STUART LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LAWRENCE
Last Name:SEGELNICK
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 1:3165 EMMONS AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1888
Mailing Address - Country:US
Mailing Address - Phone:718-743-8279
Mailing Address - Fax:
Practice Address - Street 1:3165 EMMONS AVE STE C1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1888
Practice Address - Country:US
Practice Address - Phone:718-743-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-19
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0441061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU57700Medicare UPIN