Provider Demographics
NPI:1841366366
Name:SELDEN, BENJAMIN ROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROSS
Last Name:SELDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:52722-6752
Mailing Address - Country:US
Mailing Address - Phone:563-449-1070
Mailing Address - Fax:
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:52722-6752
Practice Address - Country:US
Practice Address - Phone:563-449-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA83921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice