Provider Demographics
NPI:1801889290
Name:SELBY, LINDA (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:SELBY
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 1:5208 PHILOMATH BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333
Mailing Address - Country:US
Mailing Address - Phone:541-766-8000
Mailing Address - Fax:541-766-4667
Practice Address - Street 1:5208 PHILOMATH BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333
Practice Address - Country:US
Practice Address - Phone:541-766-8000
Practice Address - Fax:541-766-4667
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66551223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist