Provider Demographics
NPI:1639224850
Name:SELSKI, PAUL JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAY
Last Name:SELSKI
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 1:11873 KILLIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1937
Mailing Address - Country:US
Mailing Address - Phone:818-554-4226
Mailing Address - Fax:
Practice Address - Street 1:11873 KILLIMORE AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-1937
Practice Address - Country:US
Practice Address - Phone:818-554-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA511204Medicaid