Provider Demographics
NPI:1376698175
Name:DRS BASSETT WALLACE SELNER & TAYLOR
Entity Type:Organization
Organization Name:DRS BASSETT WALLACE SELNER & TAYLOR
Other - Org Name:DRS BASSETT, WALLACE & SELNER, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-488-9090
Mailing Address - Street 1:8181 E TUFTS AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2579
Mailing Address - Country:US
Mailing Address - Phone:720-488-9090
Mailing Address - Fax:720-488-9091
Practice Address - Street 1:8181 E TUFTS AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2579
Practice Address - Country:US
Practice Address - Phone:720-488-9090
Practice Address - Fax:720-488-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty