Provider Demographics
NPI:1033498738
Name:SELEM, LISA CATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CATHERINE
Last Name:SELEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:CATHERINE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19235 KATY FWY
Mailing Address - Street 2:STE 300B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1038
Mailing Address - Country:US
Mailing Address - Phone:281-647-6687
Mailing Address - Fax:
Practice Address - Street 1:19235 KATY FWY
Practice Address - Street 2:SUITE 300B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1036
Practice Address - Country:US
Practice Address - Phone:281-647-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0142831223G0001X
TX313041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice