Healthcare Provider Details

I. General information

NPI: 1982934832
Provider Name (Legal Business Name): MARBLEHEAD DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SCHOOL ST
MARBLEHEAD MA
01945-3319
US

IV. Provider business mailing address

7 BONAD RD
MARBLEHEAD MA
01945-3710
US

V. Phone/Fax

Practice location:
  • Phone: 781-631-7950
  • Fax: 781-631-7953
Mailing address:
  • Phone: 781-631-7950
  • Fax: 781-631-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FERN E, SELESNICK
Title or Position: DENTIST
Credential: DMD
Phone: 781-631-7950