Provider Demographics
NPI:1902080666
Name:SELECMAN, AUDREY MARIE (BA, DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:MARIE
Last Name:SELECMAN
Suffix:
Gender:F
Credentials:BA, DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:910 MADISON AVENUE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-6476
Mailing Address - Fax:901-448-1294
Practice Address - Street 1:875 UNION AVENUE
Practice Address - Street 2:DEPT. OF RESTORATIVE DENTISTRY
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-6101
Practice Address - Fax:901-448-1294
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDS00000087081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics