Provider Demographics
NPI:1760550552
Name:SELZNICK, JAY KEVIN (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KEVIN
Last Name:SELZNICK
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8350 W SAHARA AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8942
Mailing Address - Country:US
Mailing Address - Phone:702-436-9090
Mailing Address - Fax:702-436-3535
Practice Address - Street 1:8350 W SAHARA AVE STE 190
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8942
Practice Address - Country:US
Practice Address - Phone:702-436-9090
Practice Address - Fax:702-436-3535
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV28931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509554Medicaid
NY02679770Medicaid
NV2202788Medicaid
NY02679770Medicaid