Provider Demographics
NPI:1053652420
Name:SELLECK DDS INC A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:SELLECK DDS INC A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:DENTAL SLEEP MEDICINE OFFICES OF MICHAEL J. SELLECK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELLECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-383-0338
Mailing Address - Street 1:935 MORAGA RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4584
Mailing Address - Country:US
Mailing Address - Phone:925-283-0338
Mailing Address - Fax:
Practice Address - Street 1:935 MORAGA RD
Practice Address - Street 2:SUITE #101
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4584
Practice Address - Country:US
Practice Address - Phone:925-283-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24502332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies