Provider Demographics
NPI:1598039257
Name:SECOLA, LOURDES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:M
Last Name:SECOLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14270 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2436
Mailing Address - Country:US
Mailing Address - Phone:402-491-3100
Mailing Address - Fax:402-445-4094
Practice Address - Street 1:14270 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2436
Practice Address - Country:US
Practice Address - Phone:402-491-3100
Practice Address - Fax:402-445-4094
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025250800Medicaid