Provider Demographics
NPI:1558376194
Name:DON E SECREST DDS INC
Entity Type:Organization
Organization Name:DON E SECREST DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SECREST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-928-4422
Mailing Address - Street 1:712 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1041
Mailing Address - Country:US
Mailing Address - Phone:330-928-4422
Mailing Address - Fax:330-940-4285
Practice Address - Street 1:712 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1041
Practice Address - Country:US
Practice Address - Phone:330-928-4422
Practice Address - Fax:330-940-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty