Provider Demographics
NPI:1134540248
Name:DAN C. SELZ DDS DEBORAH J. SELZ DDS
Entity type:Organization
Organization Name:DAN C. SELZ DDS DEBORAH J. SELZ DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR DAN SELZ
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SELZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-683-4077
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty