Healthcare Provider Details

I. General information

NPI: 1407762826
Provider Name (Legal Business Name): SELAM BEKELE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LAMARTINE ST
JAMAICA PLAIN MA
02130-5345
US

IV. Provider business mailing address

PO BOX 300190
JAMAICA PLAIN MA
02130-0002
US

V. Phone/Fax

Practice location:
  • Phone: 857-258-1470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number101311
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: