Provider Demographics
NPI:1215041314
Name:SELMECZY, ENDRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ENDRE
Middle Name:
Last Name:SELMECZY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 N L ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-8005
Mailing Address - Country:US
Mailing Address - Phone:925-447-8344
Mailing Address - Fax:925-447-4074
Practice Address - Street 1:489 N L ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-8005
Practice Address - Country:US
Practice Address - Phone:925-447-8344
Practice Address - Fax:925-447-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41243023OtherSTATE TAX ID