Provider Demographics
NPI:1013126903
Name:SEGULYEV, CAROLINE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:C
Last Name:SEGULYEV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E OLIVE AVE
Mailing Address - Street 2:STE. 730
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-846-6464
Mailing Address - Fax:
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:STE. 730
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-846-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist