1063694503 NPI number — SHARON L HOLLEY DMD MONIQUE D MCEAHERN DDS ROBERT M SELDEN III DDS MS

Table of content: MARY LOUISE MARTINIUK RN (NPI 1295468858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063694503 NPI number — SHARON L HOLLEY DMD MONIQUE D MCEAHERN DDS ROBERT M SELDEN III DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON L HOLLEY DMD MONIQUE D MCEAHERN DDS ROBERT M SELDEN III DDS MS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY PEDIATRIC DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063694503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2325 W ARBORS DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-2559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-688-1664
Provider Business Mailing Address Fax Number:
704-688-1665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 W ARBORS DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-688-1664
Provider Business Practice Location Address Fax Number:
704-688-1665
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SELDEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
MILTON
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
704-992-1022

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  6877 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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