Provider Demographics
NPI:1417089038
Name:SELVIAN, MONIQUE NAIRI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:NAIRI
Last Name:SELVIAN
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 1:1886 VERDUGO LOMA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2811
Mailing Address - Country:US
Mailing Address - Phone:310-622-2828
Mailing Address - Fax:
Practice Address - Street 1:1127 E GREEN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2505
Practice Address - Country:US
Practice Address - Phone:310-622-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553721223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice