Provider Demographics
NPI:1881809945
Name:JAMES F. SELANDER, DDS
Entity type:Organization
Organization Name:JAMES F. SELANDER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FULLMER
Authorized Official - Last Name:SELANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-457-3669
Mailing Address - Street 1:832 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6419
Mailing Address - Country:US
Mailing Address - Phone:360-457-3669
Mailing Address - Fax:360-452-7998
Practice Address - Street 1:832 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6419
Practice Address - Country:US
Practice Address - Phone:360-457-3669
Practice Address - Fax:360-452-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049515Medicaid
WA1053400440OtherINDIVIDUAL NPI
WA5036868Medicaid