Organization
WEST MAPLE DENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOURDES M SECOLA DDS (PRESIDENT)
(402) 491-3100
Entity
Organization
Contact information
Practice address
14270 WEST MAPLE RD, OMAHA, NE 68164
(402) 491-3100
(402) 445-4094
Mailing address
14270 WEST MAPLE RD, OMAHA, NE 68164
(402) 491-3100
(402) 445-4094
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5942
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025250800
—
NE
Enumeration date
09/07/2006
Last updated
08/22/2020
Update your record
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