Provider Demographics
NPI:1336178425
Name:SELBE, DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SELBE
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 1:1600 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-2408
Mailing Address - Country:US
Mailing Address - Phone:610-740-3286
Mailing Address - Fax:610-740-3285
Practice Address - Street 1:1600 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2408
Practice Address - Country:US
Practice Address - Phone:610-740-3286
Practice Address - Fax:610-740-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025008L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU07703Medicare UPIN
PA182646Medicare ID - Type UnspecifiedDENTIST