Provider Demographics
NPI:1740437151
Name:SEGALL, STEVEN WALTER (DDS MS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WALTER
Last Name:SEGALL
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 MONONA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1138
Mailing Address - Country:US
Mailing Address - Phone:608-222-4777
Mailing Address - Fax:608-222-2532
Practice Address - Street 1:4002 MONONA DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1138
Practice Address - Country:US
Practice Address - Phone:608-222-4777
Practice Address - Fax:608-222-2532
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001279-0151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics