Provider Demographics
NPI:1336531185
Name:SELLERS, KENNETH STEVE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:STEVE
Last Name:SELLERS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LULLWATER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3180
Mailing Address - Country:US
Mailing Address - Phone:229-439-8896
Mailing Address - Fax:229-337-2408
Practice Address - Street 1:2301 LULLWATER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3180
Practice Address - Country:US
Practice Address - Phone:229-439-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0150001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry