Provider Demographics
NPI:1942289699
Name:SEGARS DENTAL CENTER
Entity Type:Organization
Organization Name:SEGARS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SEGARS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-402-9595
Mailing Address - Street 1:1123 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7107
Mailing Address - Country:US
Mailing Address - Phone:843-402-9595
Mailing Address - Fax:843-763-3599
Practice Address - Street 1:1123 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7107
Practice Address - Country:US
Practice Address - Phone:843-402-9595
Practice Address - Fax:843-763-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9813Medicaid