Provider Demographics
NPI:1194832345
Name:PAPE, SELENA (DDS)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:PAPE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1426
Mailing Address - Country:US
Mailing Address - Phone:502-245-8627
Mailing Address - Fax:502-245-9395
Practice Address - Street 1:9217 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8858
Practice Address - Country:US
Practice Address - Phone:502-228-2709
Practice Address - Fax:502-228-9884
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice