Provider Demographics
NPI:1861608218
Name:SELMIC, NADEZDA (DMD)
Entity type:Individual
Prefix:
First Name:NADEZDA
Middle Name:
Last Name:SELMIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E LAS OLAS BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2210
Mailing Address - Country:US
Mailing Address - Phone:617-818-4596
Mailing Address - Fax:
Practice Address - Street 1:401 E LAS OLAS BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2210
Practice Address - Country:US
Practice Address - Phone:617-818-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21213122300000X
FL204361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist