Healthcare Provider Details

I. General information

NPI: 1144291832
Provider Name (Legal Business Name): SECOR DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7924 SECOR RD
LAMBERTVILLE MI
48144
US

IV. Provider business mailing address

PO BOX 297
LAMBERTVILLE MI
48144
US

V. Phone/Fax

Practice location:
  • Phone: 734-856-3004
  • Fax: 734-856-5336
Mailing address:
  • Phone: 734-856-3004
  • Fax: 734-856-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901015738
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29010014395
License Number StateMI

VIII. Authorized Official

Name: DR. CYNTHIA A DENIS
Title or Position: PRES/DDS
Credential: DDS
Phone: 734-856-3004