MEDICARE: NADEZDA SELMIC DMD

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	122300000X	Dentist	21213	MA
2	1223G0001X	General Practice Dentistry	20436	FL

General Provider Information

NPI Number	:	1861608218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEZDA SELMIC DMD

Provider Business Mailing Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE #140
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	617-818-4596
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE #140
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	617-818-4596
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	11/30/2013

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