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NPI Code Detail

MEDICARE: DR. LOURDES M SECOLA DDS

MEDICARE: DR. LOURDES M SECOLA DDS
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
11223P0221XPediatric Dentistry5942NE

Other Identifiers

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

General Provider Information

NPI Number : 1598039257
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOURDES M SECOLA DDS
Provider Business Mailing Address
First Line : 14270 W MAPLE RD
Second Line :
City : OMAHA
State : NE
Zip : 68164-2436
Country : US
Telephone Number : 402-491-3100
Fax Number : 402-445-4094
Provider Business Practice Location Address
First Line : 14270 W MAPLE RD
Second Line :
City : OMAHA
State : NE
Zip : 68164-2436
Country : US
Telephone Number : 402-491-3100
Fax Number : 402-445-4094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2012
Last Update Date : 02/28/2012

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