Healthcare Provider Details

I. General information

NPI: 1114050085
Provider Name (Legal Business Name): JEFFREY A SEKERAK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 ALLEN RD STE 105
ALLEN PARK MI
48101-1281
US

IV. Provider business mailing address

15090 ENGLEWOOD AVE
ALLEN PARK MI
48101-1628
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-3000
  • Fax: 313-383-1631
Mailing address:
  • Phone: 313-383-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14744
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: