Provider Demographics
NPI:1568830677
Name:SELVARAJ, ARCHANA (DMD)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:SELVARAJ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VINTON ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3928
Mailing Address - Country:US
Mailing Address - Phone:603-627-8800
Mailing Address - Fax:
Practice Address - Street 1:8 VINTON ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3928
Practice Address - Country:US
Practice Address - Phone:603-627-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice