Provider Demographics
NPI:1649559766
Name:SELLAS, SOPHIA CRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:CRISTINA
Last Name:SELLAS
Suffix:
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 1:1875 BUSINESS CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3416
Mailing Address - Country:US
Mailing Address - Phone:909-557-7543
Mailing Address - Fax:
Practice Address - Street 1:1875 BUSINESS CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3416
Practice Address - Country:US
Practice Address - Phone:909-557-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist