Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DH031977 | CA |
NPI | 1295810869 |
---|---|
Provider Name | Dr. James Peter Sellas |
First Address | San Bernardino, CA 92408-3416 |
Second Address | San Bernardino, CA 92408-3416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |