Provider Demographics
NPI:1942929112
Name:ROJO SEGURA, PEDRO (RDH)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:ROJO SEGURA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 S SCEPTER DR APT 14
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2252
Mailing Address - Country:US
Mailing Address - Phone:414-477-4616
Mailing Address - Fax:
Practice Address - Street 1:5960 W BROWN DEER RD STE 202
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2310
Practice Address - Country:US
Practice Address - Phone:414-331-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
WI124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty