Provider Demographics
NPI:1760819551
Name:JAMES F SELANDER DDS PC
Entity Type:Organization
Organization Name:JAMES F SELANDER DDS PC
Other - Org Name:TYSONS CORNER DENTISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-848-8889
Mailing Address - Street 1:8296 OLD COURTHOUSE RD
Mailing Address - Street 2:A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8110 MADRILLON CT
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3750
Practice Address - Country:US
Practice Address - Phone:703-848-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental