Provider Demographics
NPI:1932306339
Name:SELZER, ASA BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASA
Middle Name:BRENT
Last Name:SELZER
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 1:8604 S NORMANDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6140
Mailing Address - Country:US
Mailing Address - Phone:817-244-0180
Mailing Address - Fax:817-244-0180
Practice Address - Street 1:8604 S NORMANDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6140
Practice Address - Country:US
Practice Address - Phone:817-244-0180
Practice Address - Fax:817-244-0180
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist