Provider Demographics
NPI:1891037362
Name:MAIKEL SEGUI DDS PA
Entity Type:Organization
Organization Name:MAIKEL SEGUI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-752-9065
Mailing Address - Street 1:2123 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6134
Mailing Address - Country:US
Mailing Address - Phone:954-752-9065
Mailing Address - Fax:
Practice Address - Street 1:2123 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6134
Practice Address - Country:US
Practice Address - Phone:954-752-9065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty