Individual
TIEG BRYANT SELBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
116 MAGNOLIA DR, GLEN CARBON, IL 62034-1595
(618) 288-5437
Mailing address
5 ABBEY RD, GLEN CARBON, IL 62034-2928
(612) 203-1034
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
021.002920
IL
Other
Enumeration date
04/11/2011
Last updated
12/13/2021
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