Provider Demographics
NPI:1710450754
Name:DRS SELBERG & RICE PLLC
Entity Type:Organization
Organization Name:DRS SELBERG & RICE PLLC
Other - Org Name:ASSOCIATED PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-622-2916
Mailing Address - Street 1:4945 STONE FALLS CTR STE B
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7801
Mailing Address - Country:US
Mailing Address - Phone:618-622-0212
Mailing Address - Fax:
Practice Address - Street 1:4945 STONE FALLS CTR STE B
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-7801
Practice Address - Country:US
Practice Address - Phone:618-622-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty