Provider Demographics
NPI:1518989854
Name:SELLERS, JOHN GREATON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREATON
Last Name:SELLERS
Suffix:JR
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3879 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2512
Mailing Address - Country:US
Mailing Address - Phone:703-352-5814
Mailing Address - Fax:
Practice Address - Street 1:3879 PLAZA DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2512
Practice Address - Country:US
Practice Address - Phone:703-691-9041
Practice Address - Fax:703-691-9239
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice