Healthcare Provider Details

I. General information

NPI: 1104022219
Provider Name (Legal Business Name): PHILIP MORTON SELGREN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 N CTY HY F
JANESVILLE WI
53545
US

IV. Provider business mailing address

1711 N SUMAC DR
JANESVILLE WI
56545
US

V. Phone/Fax

Practice location:
  • Phone: 608-757-5318
  • Fax:
Mailing address:
  • Phone: 608-752-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number115E
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: