Healthcare Provider Details

I. General information

NPI: 1902080666
Provider Name (Legal Business Name): AUDREY MARIE SELECMAN BA, DDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVENUE DEPT. OF RESTORATIVE DENTISTRY
MEMPHIS TN
38163-0001
US

IV. Provider business mailing address

910 MADISON AVENUE SUITE 608
MEMPHIS TN
38163-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6101
  • Fax: 901-448-1294
Mailing address:
  • Phone: 901-448-6476
  • Fax: 901-448-1294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS0000008708
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: