Provider Demographics
NPI:1114050085
Name:SEKERAK, JEFFREY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:SEKERAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15090 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1628
Mailing Address - Country:US
Mailing Address - Phone:313-383-6174
Mailing Address - Fax:
Practice Address - Street 1:10501 ALLEN RD
Practice Address - Street 2:STE 105
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1281
Practice Address - Country:US
Practice Address - Phone:313-383-3000
Practice Address - Fax:313-383-1631
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI147441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice