Provider Demographics
NPI:1770543654
Name:SELLERS, GRAYSON L (DDS)
Entity type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:L
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 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:956-454-9862
Mailing Address - Fax:
Practice Address - Street 1:810 W OCEAN BLVD C1
Practice Address - Street 2:
Practice Address - City:LOS TRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566
Practice Address - Country:US
Practice Address - Phone:956-233-4400
Practice Address - Fax:956-233-5626
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice