Individual provider Active NPI

William David Selecman, D.D.S.

  • General Practice Dentistry
  • Crossville, TN
National Provider Identifier
1043325376
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS2563 Issued in TN
Practice address
66 West Ave
Crossville, TN 38555-4773
Phone
(931) 484-5724
Fax
(931) 484-5724
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS2563 TN Primary

Addresses

Primary practice location

66 West Ave
Crossville, TN 38555-4773

Mailing address

66 West Ave
Crossville, TN 38555-4773
Phone (931) 484-5724

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151116000415 TN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7214247683

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS2563TNMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043325376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 WEST AVE",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554773",
            "telephone_number": "931-484-5724",
            "fax_number": "931-484-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 WEST AVE",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554773",
            "telephone_number": "931-484-5724",
            "fax_number": "931-484-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELECMAN",
        "first_name": "WILLIAM",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS2563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.