Provider Demographics
NPI:1386817567
Name:SELENOU-TEMA, ALAIN (DDS)
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:SELENOU-TEMA
Suffix:
Gender:M
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:PO BOX 11234
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1234
Mailing Address - Country:US
Mailing Address - Phone:240-838-1583
Mailing Address - Fax:
Practice Address - Street 1:4210 MARTIN WAY E
Practice Address - Street 2:101
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5325
Practice Address - Country:US
Practice Address - Phone:360-455-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60085475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist