Provider Demographics
NPI:1457551954
Name:SELLERS, BRUCE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:SELLERS
Suffix:
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 1:408 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4728
Mailing Address - Country:US
Mailing Address - Phone:503-362-3032
Mailing Address - Fax:503-362-4647
Practice Address - Street 1:408 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4728
Practice Address - Country:US
Practice Address - Phone:503-362-3032
Practice Address - Fax:503-362-4647
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89451223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health