Provider Demographics
NPI:1881820868
Name:SENA, ROBERT THOMAS (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:SENA
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 1:315 BALTIMORE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3913
Mailing Address - Country:US
Mailing Address - Phone:616-235-1005
Mailing Address - Fax:
Practice Address - Street 1:315 BALTIMORE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3913
Practice Address - Country:US
Practice Address - Phone:616-235-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist