Provider Demographics
NPI:1578619714
Name:SELTZER, GREGORY GLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GLEN
Last Name:SELTZER
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 1:215 N 10TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2389
Mailing Address - Country:US
Mailing Address - Phone:406-363-5300
Mailing Address - Fax:406-363-0308
Practice Address - Street 1:215 N 10TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2389
Practice Address - Country:US
Practice Address - Phone:406-363-5300
Practice Address - Fax:406-363-0308
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT129857Medicaid