Provider Demographics
NPI:1427103969
Name:DAVID C. SECORD, D.D.S., P.C.
Entity type:Organization
Organization Name:DAVID C. SECORD, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SECORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:313-884-9585
Mailing Address - Street 1:20259 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1773
Mailing Address - Country:US
Mailing Address - Phone:313-884-9585
Mailing Address - Fax:313-884-3265
Practice Address - Street 1:20259 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1773
Practice Address - Country:US
Practice Address - Phone:313-884-9585
Practice Address - Fax:313-884-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010109211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty