Healthcare Provider Details

I. General information

NPI: 1528074200
Provider Name (Legal Business Name): DAVID G. SELUK, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N SHELDON RD
PLYMOUTH MI
48170-1524
US

IV. Provider business mailing address

213 N SHELDON RD
PLYMOUTH MI
48170-1524
US

V. Phone/Fax

Practice location:
  • Phone: 734-453-4150
  • Fax: 734-459-1828
Mailing address:
  • Phone: 734-453-4150
  • Fax: 734-459-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017082
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID GERARD SELUK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 734-453-4150