Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5055 | NC |
NPI | 1043334311 |
---|---|
Provider Name | Keith T Sellers |
First Address | Charlotte, NC 28226-8061 |
Second Address | Charlotte, NC 28226-8061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |