Provider Demographics
NPI:1013678465
Name:JAMES SEGULYEV DDS PLLC
Entity Type:Organization
Organization Name:JAMES SEGULYEV DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGULYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-661-3666
Mailing Address - Street 1:14785 PRESTON RD STE 790
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7875
Mailing Address - Country:US
Mailing Address - Phone:972-661-3666
Mailing Address - Fax:
Practice Address - Street 1:14785 PRESTON RD STE 790
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7875
Practice Address - Country:US
Practice Address - Phone:972-661-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty