MEDICARE: DR. HERBERT - SELIPSKY D.D.S., M.S.D.

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	1223P0300X	Periodontics	4402	WA

General Provider Information

NPI Number	:	1437219243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT - SELIPSKY D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	DR. H.SELIPSKY, 3828 NE 151ST STREET
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98155
Country	:	US
Telephone Number	:	206-365-8486
Fax Number	:	206-364-3334

Provider Business Practice Location Address
First Line	:	1001 BROADWAY
Second Line	:	SUITE 311
City	:	SEATTLE
State	:	WA
Zip	:	98122-4397
Country	:	US
Telephone Number	:	206-323-7659
Fax Number	:	206-323-0733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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