Provider Demographics
NPI:1922849769
Name:JOHN SELPH, DMD, PLLC
Entity type:Organization
Organization Name:JOHN SELPH, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-334-3874
Mailing Address - Street 1:3 BEN HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-8100
Mailing Address - Country:US
Mailing Address - Phone:440-334-3874
Mailing Address - Fax:
Practice Address - Street 1:829 FLEMING ST STE B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3560
Practice Address - Country:US
Practice Address - Phone:440-334-3874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty