Active NPI
Michael James Selleck, D.D.S.
- General Practice Dentistry
- Lafayette, CA
National Provider Identifier
1275747651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 24502
- Practice address
- 935 Moraga Rd
Suite 101
Lafayette, CA 94549-4584 - Phone
- (925) 283-0338
- Fax
- (925) 283-0360
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 24502 | CA | Primary |
Addresses
Primary practice location
935 Moraga Rd
Suite 101
Lafayette, CA 94549-4584
Mailing address
935 Moraga Rd
Suite 101
Lafayette, CA 94549-4584
Phone (925) 283-0338
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20-2381272 | Other | CA | TAX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24502 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362960000000",
"number": "1275747651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "935 MORAGA RD",
"address_2": "SUITE 101",
"city": "LAFAYETTE",
"state": "CA",
"postal_code": "945494584",
"telephone_number": "925-283-0338",
"fax_number": "925-283-0360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "935 MORAGA RD",
"address_2": "SUITE 101",
"city": "LAFAYETTE",
"state": "CA",
"postal_code": "945494584",
"telephone_number": "925-283-0338",
"fax_number": "925-283-0360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLECK",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2013-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "24502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX",
"identifier": "20-2381272",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.