Provider Demographics
NPI:1528772373
Name:MARIA L SEGURA DMD, PC
Entity type:Organization
Organization Name:MARIA L SEGURA DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-588-0094
Mailing Address - Street 1:304 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3234
Mailing Address - Country:US
Mailing Address - Phone:508-588-0094
Mailing Address - Fax:
Practice Address - Street 1:304 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3234
Practice Address - Country:US
Practice Address - Phone:508-588-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1912106303OtherDDS
MA1861575268OtherDDS
MA1568536811OtherDMD
MA1891845525OtherDMD