Individual
DR. JENNIFER ERIN SECREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
200 DON ALLEN RD, LOUISVILLE, KY 40207-3910
(502) 727-4974
Mailing address
10300 LINN STATION RD STE 100, LOUISVILLE, KY 40223-3840
(502) 410-1710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12010855A
IN
1223G0001X
General Practice Dentistry
Primary
8399
KY
1223P0221X
Pediatric Dentistry
8399
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200835020
—
IN
Enumeration date
12/13/2006
Last updated
07/12/2023
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