Provider Demographics
NPI:1003000233
Name:ROBERT SELIS DDS.INC
Entity Type:Organization
Organization Name:ROBERT SELIS DDS.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-283-2093
Mailing Address - Street 1:3530 CAMINO DEL RIO N
Mailing Address - Street 2:109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1743
Mailing Address - Country:US
Mailing Address - Phone:619-283-2093
Mailing Address - Fax:
Practice Address - Street 1:3530 CAMINO DEL RIO N
Practice Address - Street 2:109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1743
Practice Address - Country:US
Practice Address - Phone:619-283-2093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD18406OtherDENTICAL