Provider Demographics
NPI:1255538476
Name:SELZER, SAMUEL ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROBERT
Last Name:SELZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 LINDEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027
Mailing Address - Country:US
Mailing Address - Phone:215-884-0477
Mailing Address - Fax:215-884-6045
Practice Address - Street 1:5 N HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033
Practice Address - Country:US
Practice Address - Phone:856-429-5612
Practice Address - Fax:856-429-8388
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100876100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS1486768OtherDEA