Provider Demographics
NPI:1558600288
Name:J. STEPHEN SELDEN DDS AND ASSOCIATES, PA
Entity Type:Organization
Organization Name:J. STEPHEN SELDEN DDS AND ASSOCIATES, PA
Other - Org Name:SMILES BY DESIGN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-637-6717
Mailing Address - Street 1:1107 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2287
Mailing Address - Country:US
Mailing Address - Phone:704-637-6717
Mailing Address - Fax:
Practice Address - Street 1:1107 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2287
Practice Address - Country:US
Practice Address - Phone:704-637-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9850122300000X
NC70481223G0001X
NC92331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty