Provider Demographics
NPI:1326204652
Name:SELLE, BENJAMIN THEODORE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:THEODORE
Last Name:SELLE
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 1:51 MILL ST
Mailing Address - Street 2:#2 BAYSIDE VILLAGE
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4361
Mailing Address - Country:US
Mailing Address - Phone:603-569-1554
Mailing Address - Fax:
Practice Address - Street 1:51 MILL ST
Practice Address - Street 2:#2 BAYSIDE VILLAGE
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4361
Practice Address - Country:US
Practice Address - Phone:603-569-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice