Provider Demographics
NPI:1467155747
Name:SELLERS FAMILY LIMITED PARTNERSHIP ALPHA
Entity Type:Organization
Organization Name:SELLERS FAMILY LIMITED PARTNERSHIP ALPHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRAYSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-434-9365
Mailing Address - Street 1:110 SAN ANTONIO CIR
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4315
Mailing Address - Country:US
Mailing Address - Phone:956-434-9365
Mailing Address - Fax:
Practice Address - Street 1:110 SAN ANTONIO CIR
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4315
Practice Address - Country:US
Practice Address - Phone:956-434-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty