MEDICARE: SELINA ASANTE 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	122300000X	Dentist	14890	MD

General Provider Information

NPI Number	:	1831450972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELINA ASANTE DDS

Provider Business Mailing Address
First Line	:	5700 RITCHIE HWY
Second Line	:
City	:	BROOKLYN PARK
State	:	MD
Zip	:	21225-3641
Country	:	US
Telephone Number	:	410-589-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 RITCHIE HWY
Second Line	:
City	:	BROOKLYN PARK
State	:	MD
Zip	:	21225-3641
Country	:	US
Telephone Number	:	410-589-0711
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	03/04/2015

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