Provider Demographics
NPI:1215035225
Name:SELBY, DAN EDWARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:EDWARD
Last Name:SELBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 HUMBOLDT RD
Mailing Address - Street 2:STE C
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-891-1111
Mailing Address - Fax:530-891-1141
Practice Address - Street 1:1459 HUMBOLDT RD
Practice Address - Street 2:STE C
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-891-1111
Practice Address - Fax:530-891-1141
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist