Provider Demographics
NPI:1508892043
Name:SEGURA, ADRIANA (DDS)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:SEGURA
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:P.O. BOX 40397
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:210-567-3274
Mailing Address - Fax:210-567-2844
Practice Address - Street 1:630 S GENERAL MCMULLEN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-2005
Practice Address - Country:US
Practice Address - Phone:210-567-3274
Practice Address - Fax:210-567-2844
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163031223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16303OtherTEXAS DENTAL LICENSE
TX090793302Medicaid
TX090793306Medicaid