Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D8945 | OR |
NPI | 1457551954 |
---|---|
Provider Name | Dr. Bruce A. Sellers |
First Address | Salem, OR 97301-4728 |
Second Address | Salem, OR 97301-4728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |