Provider Demographics
NPI:1033263892
Name:SELDEN, ROBERT MILTON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MILTON
Last Name:SELDEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-1988
Mailing Address - Fax:757-461-6188
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-1988
Practice Address - Fax:757-461-6188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010040171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice