Individual
JOSE L OLIVER SEGARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6382
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 251-6382
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
003529
PR
122300000X
Dentist
Primary
2025052674
MO
1223G0001X
General Practice Dentistry
Primary
2025052674
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/04/2024
Last updated
08/11/2026
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