Provider Demographics
NPI:1023291424
Name:SELZER, ASA DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:ASA
Middle Name:DALE
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:PO BOX 235
Mailing Address - Street 2:667 C. R. 2421
Mailing Address - City:LEESBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75451-0235
Mailing Address - Country:US
Mailing Address - Phone:903-717-1156
Mailing Address - Fax:
Practice Address - Street 1:667 COUNTY ROAD 2421
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:TX
Practice Address - Zip Code:75451-2291
Practice Address - Country:US
Practice Address - Phone:903-717-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice