Provider Demographics
NPI:1316060676
Name:SEGAT, THERESA E (DMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:E
Last Name:SEGAT
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 1:841 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2026
Mailing Address - Country:US
Mailing Address - Phone:201-265-0450
Mailing Address - Fax:201-265-4020
Practice Address - Street 1:841 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2026
Practice Address - Country:US
Practice Address - Phone:201-265-0450
Practice Address - Fax:201-265-4020
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01136900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist