Provider Demographics
NPI:1164913273
Name:SELINSGROVE DENTAL & DENTURES INC
Entity Type:Organization
Organization Name:SELINSGROVE DENTAL & DENTURES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-376-6328
Mailing Address - Street 1:111 HOMEPORT DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5410
Mailing Address - Country:US
Mailing Address - Phone:716-954-0141
Mailing Address - Fax:
Practice Address - Street 1:2192 NORTH SUSQUEHANNA TRAIL
Practice Address - Street 2:SUITE 200
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17831
Practice Address - Country:US
Practice Address - Phone:570-743-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental