Provider Demographics
NPI:1215994223
Name:SENECAL, JEAN-CLAUDE (DMD)
Entity type:Individual
Prefix:DR
First Name:JEAN-CLAUDE
Middle Name:
Last Name:SENECAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 GROSS POINT RD #106
Mailing Address - Street 2:106
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:910-257-5591
Mailing Address - Fax:502-624-2966
Practice Address - Street 1:2555 GROSS POINT RD
Practice Address - Street 2:UNIT 106
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:910-257-5591
Practice Address - Fax:502-624-3430
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190238751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice