Provider Demographics
NPI:1265560148
Name:SEGALL, BERNARD W (DMD,MS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:W
Last Name:SEGALL
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:W
Other - Last Name:SEGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MS
Mailing Address - Street 1:2601 S BAYSHORE DR
Mailing Address - Street 2:SUITE # 760
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5417
Mailing Address - Country:US
Mailing Address - Phone:305-857-0990
Mailing Address - Fax:305-857-9180
Practice Address - Street 1:2601 S BAYSHORE DR
Practice Address - Street 2:SUITE # 760
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-5417
Practice Address - Country:US
Practice Address - Phone:305-857-0990
Practice Address - Fax:305-857-9180
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00057961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84978Medicare ID - Type Unspecified