Healthcare Provider Details

I. General information

NPI: 1386817567
Provider Name (Legal Business Name): ALAIN SELENOU-TEMA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 MARTIN WAY E 101
OLYMPIA WA
98516-5325
US

IV. Provider business mailing address

PO BOX 11234
OLYMPIA WA
98508-1234
US

V. Phone/Fax

Practice location:
  • Phone: 360-455-9544
  • Fax:
Mailing address:
  • Phone: 240-838-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60085475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: