Provider Demographics
NPI:1265622062
Name:SEGURA, JOSE CAMILO (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CAMILO
Last Name:SEGURA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3909
Mailing Address - Country:US
Mailing Address - Phone:781-843-7800
Mailing Address - Fax:781-356-8182
Practice Address - Street 1:300 GRANITE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-3909
Practice Address - Country:US
Practice Address - Phone:781-843-7800
Practice Address - Fax:781-356-8182
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics