Rejuv Skin & Laser Clinic

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D9967 Issued in MN

Legal business name

REJUV SKIN & LASER CLINIC

Practice address

1625 Lena CT Ste 300
Eagan, MN 55122-2938

Phone

(651) 287-3080

Fax

(651) 905-3789

NPI assigned

Jul 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Steven Allen Selchow, DDS

Title

Owner

Phone

(651) 287-3080

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184284800000",
    "number": "1669671152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 LENA CT STE 300",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222938",
            "telephone_number": "651-287-3080",
            "fax_number": "651-905-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 LENA CT STE 300",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222938",
            "telephone_number": "651-287-3080",
            "fax_number": "651-905-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUV SKIN & LASER CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2007-07-13",
        "status": "A",
        "authorized_official_last_name": "SELCHOW",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-287-3080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D9967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Eagan, MN
• Providers in Eagan, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.