Provider Demographics
NPI:1013139310
Name:JOHN S.SELDEN,DDS,PA
Entity type:Organization
Organization Name:JOHN S.SELDEN,DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:704-597-3493
Mailing Address - Street 1:2315 WEST ARBORS DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2639
Mailing Address - Country:US
Mailing Address - Phone:704-597-3493
Mailing Address - Fax:704-597-3494
Practice Address - Street 1:2315 WEST ARBORS DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2639
Practice Address - Country:US
Practice Address - Phone:704-597-3493
Practice Address - Fax:704-597-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty