| NPI | 1740550417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN R SELDEN Copresident 563-449-1070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 08392) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 7655) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |