Provider Demographics
NPI:1447839659
Name:TOTONCHI, SELAM K (DMD)
Entity type:Individual
Prefix:DR
First Name:SELAM
Middle Name:K
Last Name:TOTONCHI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W285 GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2239
Mailing Address - Country:US
Mailing Address - Phone:630-260-0333
Mailing Address - Fax:
Practice Address - Street 1:26W285 GENEVA RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2239
Practice Address - Country:US
Practice Address - Phone:630-260-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190330661223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice