Healthcare Provider Details

I. General information

NPI: 1033598040
Provider Name (Legal Business Name): AVA SELYA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W SCHUYLKILL RD STE G-15A
POTTSTOWN PA
19465-7438
US

IV. Provider business mailing address

351 W SCHUYLKILL RD STE G-15A
POTTSTOWN PA
19465-7438
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-9460
  • Fax: 610-222-5006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001530
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16045
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040350
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: