MEDICARE: MICHAEL ROBERT SELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11131	TX

General Provider Information

NPI Number	:	1699834804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBERT SELL DDS

Provider Business Mailing Address
First Line	:	1349 S VOSS
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057
Country	:	US
Telephone Number	:	713-780-4507
Fax Number	:	713-780-9537

Provider Business Practice Location Address
First Line	:	1349 S VOSS
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057
Country	:	US
Telephone Number	:	713-780-4507
Fax Number	:	713-780-9537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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