MEDICARE: SUSAN SEKRETA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	050369	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073695177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SEKRETA D.D.S.

Provider Business Mailing Address
First Line	:	103 BURROWS RD STE 1
Second Line	:
City	:	WEST WINFIELD
State	:	NY
Zip	:	13491-2830
Country	:	US
Telephone Number	:	315-822-4321
Fax Number	:	315-822-3284

Provider Business Practice Location Address
First Line	:	103 BURROWS RD STE 1
Second Line	:
City	:	WEST WINFIELD
State	:	NY
Zip	:	13491-2830
Country	:	US
Telephone Number	:	315-822-4321
Fax Number	:	315-822-3284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/22/2015

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