Provider Demographics
NPI:1316757289
Name:SEGOVIA ORTHODONTICS AT LAKEWOOD RANCH
Entity type:Organization
Organization Name:SEGOVIA ORTHODONTICS AT LAKEWOOD RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-557-1333
Mailing Address - Street 1:5803 BRADEN RUN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9402
Mailing Address - Country:US
Mailing Address - Phone:941-557-1333
Mailing Address - Fax:941-557-1311
Practice Address - Street 1:5803 BRADEN RUN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-9402
Practice Address - Country:US
Practice Address - Phone:941-557-1333
Practice Address - Fax:941-557-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty