Provider Demographics
NPI:1649694811
Name:SELBY, CATHRYN (RDHAP)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:SELBY
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CREST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1810
Mailing Address - Country:US
Mailing Address - Phone:415-713-4395
Mailing Address - Fax:415-454-4829
Practice Address - Street 1:66 CREST RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1810
Practice Address - Country:US
Practice Address - Phone:415-713-4395
Practice Address - Fax:415-454-4829
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist