Provider Demographics
NPI:1104821156
Name:SELDIN, HARRIET F (DMD)
Entity type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:F
Last Name:SELDIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:STE B113
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5356
Mailing Address - Country:US
Mailing Address - Phone:858-274-2483
Mailing Address - Fax:
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:STE B113
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5356
Practice Address - Country:US
Practice Address - Phone:858-274-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADK0333701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADK033370OtherDENTAL LICENSE NUMBER