Provider Demographics
NPI:1770594426
Name:SEGURA NIEVES, SENEN (DDS)
Entity type:Individual
Prefix:
First Name:SENEN
Middle Name:
Last Name:SEGURA NIEVES
Suffix:
Gender:M
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:PO BOX 6112
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5112
Mailing Address - Country:US
Mailing Address - Phone:787-798-4835
Mailing Address - Fax:787-798-4840
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO 306
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-4835
Practice Address - Fax:787-798-4840
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice