Healthcare Provider Details

I. General information

NPI: 1437219243
Provider Name (Legal Business Name): HERBERT - SELIPSKY D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BROADWAY SUITE 311
SEATTLE WA
98122-4397
US

IV. Provider business mailing address

DR. H.SELIPSKY, 3828 NE 151ST STREET
SEATTLE WA
98155
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-7659
  • Fax: 206-323-0733
Mailing address:
  • Phone: 206-365-8486
  • Fax: 206-364-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4402
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: