Provider Demographics
NPI:1811022379
Name:MEYLAN-SENKOWSKI, GINA LYN
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:LYN
Last Name:MEYLAN-SENKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:LYN
Other - Last Name:MEYLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3737 E MONROE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8836
Mailing Address - Country:US
Mailing Address - Phone:989-486-1219
Mailing Address - Fax:
Practice Address - Street 1:4933 MACKINAW RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7248
Practice Address - Country:US
Practice Address - Phone:989-792-1593
Practice Address - Fax:989-792-6003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018380332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4424058Medicaid