Provider Demographics
NPI:1770920910
Name:SELLS, CARLEEN BURT (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLEEN
Middle Name:BURT
Last Name:SELLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLUE MOON XING STE 103
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9809
Mailing Address - Country:US
Mailing Address - Phone:912-737-4044
Mailing Address - Fax:
Practice Address - Street 1:100 BLUE MOON XING STE 103
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9809
Practice Address - Country:US
Practice Address - Phone:912-737-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014621122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist