Provider Demographics
NPI:1063694503
Name:SHARON L HOLLEY DMD MONIQUE D MCEAHERN DDS ROBERT M SELDEN III DDS MS
Entity type:Organization
Organization Name:SHARON L HOLLEY DMD MONIQUE D MCEAHERN DDS ROBERT M SELDEN III DDS MS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:704-992-1022
Mailing Address - Street 1:2325 W ARBORS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2559
Mailing Address - Country:US
Mailing Address - Phone:704-688-1664
Mailing Address - Fax:704-688-1665
Practice Address - Street 1:2325 W ARBORS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2559
Practice Address - Country:US
Practice Address - Phone:704-688-1664
Practice Address - Fax:704-688-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6877261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental