MEDICARE: JUDITH S. PABST, D.D.S.,INC. AND SHOHREH SELKI, D.D.S. A PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	031691	CA
2	1223P0221X	Pediatric Dentistry	41051	CA
3	1223P0221X	Pediatric Dentistry	224160	CA

General Provider Information

NPI Number	:	1053527002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH S. PABST, D.D.S.,INC. AND SHOHREH SELKI, D.D.S. A PARTNERSHIP

Provider Business Mailing Address
First Line	:	29525 CANWOOD ST
Second Line	:	STE 201
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4233
Country	:	US
Telephone Number	:	818-991-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	29525 CANWOOD ST STE 201
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4231
Country	:	US
Telephone Number	:	818-991-8010
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ELAINE TANASSY
Credential	:
Telephone Number	:	818-991-8010

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	10/28/2010

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