MEDICARE: DR. HARRIET F SELDIN DMD

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	DK033370	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DK033370	OTHER	CA	DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1104821156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRIET F SELDIN DMD

Provider Business Mailing Address
First Line	:	3737 MORAGA AVE
Second Line	:	STE B113
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5356
Country	:	US
Telephone Number	:	858-274-2483
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE
Second Line	:	STE B113
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5356
Country	:	US
Telephone Number	:	858-274-2483
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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