Provider Demographics
NPI:1710199476
Name:SELZ, DAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:C
Last Name:SELZ
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 1:811 HALSELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-3025
Mailing Address - Country:US
Mailing Address - Phone:940-683-4077
Mailing Address - Fax:940-683-2935
Practice Address - Street 1:811 HALSELL ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-3025
Practice Address - Country:US
Practice Address - Phone:940-683-4077
Practice Address - Fax:940-683-2935
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice