Provider Demographics
NPI:1740550417
Name:AAA COURT FAMILY DENTAL,P.C.
Entity type:Organization
Organization Name:AAA COURT FAMILY DENTAL,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COPRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-449-1070
Mailing Address - Street 1:2820 AAA CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6753
Mailing Address - Country:US
Mailing Address - Phone:563-449-1070
Mailing Address - Fax:563-449-1072
Practice Address - Street 1:2820 AAA CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6753
Practice Address - Country:US
Practice Address - Phone:563-449-1070
Practice Address - Fax:563-449-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN08392122300000X
IA7655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty