Healthcare Provider Details

I. General information

NPI: 1760550552
Provider Name (Legal Business Name): JAY KEVIN SELZNICK D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/30/2022
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 W SAHARA AVE STE 190
LAS VEGAS NV
89117-8942
US

IV. Provider business mailing address

8350 W SAHARA AVE STE 190
LAS VEGAS NV
89117-8942
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-9090
  • Fax: 702-436-3535
Mailing address:
  • Phone: 702-436-9090
  • Fax: 702-436-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2893
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: