Provider Demographics
NPI:1629269196
Name:SECREST, JOSHUA LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LAWRENCE
Last Name:SECREST
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 1:2231 DIAMOND POINT RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4604
Mailing Address - Country:US
Mailing Address - Phone:989-354-4100
Mailing Address - Fax:
Practice Address - Street 1:2231 DIAMOND POINT RD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4604
Practice Address - Country:US
Practice Address - Phone:989-354-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029282122300000X
MI2901019643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist