MEDICARE: DR. PAUL SELINGER D.M.D.

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	029253-1	NY

General Provider Information

NPI Number	:	1407854664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL SELINGER D.M.D.

Provider Business Mailing Address
First Line	:	6503 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-6248
Country	:	US
Telephone Number	:	718-456-0360
Fax Number	:	718-813-6524

Provider Business Practice Location Address
First Line	:	6503 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-6248
Country	:	US
Telephone Number	:	718-456-0360
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	06/20/2011

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