Provider Demographics
NPI:1003701020
Name:SEGURO, DIANA ZULEMA (DMD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ZULEMA
Last Name:SEGURO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 BAY RD APT 1422
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4156
Mailing Address - Country:US
Mailing Address - Phone:786-237-1297
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 205B
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1330
Practice Address - Country:US
Practice Address - Phone:954-296-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL304111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice