Healthcare Provider Details

I. General information

NPI: 1255368064
Provider Name (Legal Business Name): ALAN GARY SELBST D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD DR SUITE 112
HOUSTON TX
77024-2420
US

IV. Provider business mailing address

902 FROSTWOOD DR SUITE 112
HOUSTON TX
77024-2420
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-1166
  • Fax: 713-461-3950
Mailing address:
  • Phone: 713-461-1166
  • Fax: 713-461-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: