Healthcare Provider Details

I. General information

NPI: 1598039257
Provider Name (Legal Business Name): LOURDES M SECOLA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14270 W MAPLE RD
OMAHA NE
68164-2436
US

IV. Provider business mailing address

14270 W MAPLE RD
OMAHA NE
68164-2436
US

V. Phone/Fax

Practice location:
  • Phone: 402-491-3100
  • Fax: 402-445-4094
Mailing address:
  • Phone: 402-491-3100
  • Fax: 402-445-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5942
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: