Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 31304 | TX |
N | 1223G0001X | General Practice | DN014283 | GA |
N | 213EG0000X | General Practice | DN014283 | GA |
NPI | 1033498738 |
---|---|
Provider Name | Dr. Lisa Catherine Selem |
First Address | Houston, TX 77094-1038 |
Second Address | Houston, TX 77094-1036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2011 |
Last Update Date | 29/02/2016 |