Healthcare Provider Details

I. General information

NPI: 1801889290
Provider Name (Legal Business Name): LINDA SELBY D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 PHILOMATH BLVD
CORVALLIS OR
97333
US

IV. Provider business mailing address

5208 PHILOMATH BLVD
CORVALLIS OR
97333
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-8000
  • Fax: 541-766-4667
Mailing address:
  • Phone: 541-766-8000
  • Fax: 541-766-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6655
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6655
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: