Individual
DR. BRENT JONATHON SELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1560 WESTERN DR, DICKINSON, ND 58601-3155
(701) 483-9801
(701) 483-9803
Mailing address
1560 WESTERN DR, DICKINSON, ND 58601-3155
(701) 483-9801
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1914
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01345827
TRICARE DENTAL INSURANCE
ND
05
—
41288
—
ND
01
—
901914
BLUE CROSS BLUE SHIELD
ND
01
—
V01914
TEXAS BLUE CROSS BLUE SHI
TX
Enumeration date
06/20/2005
Last updated
05/11/2009
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