Provider Demographics
NPI:1447692264
Name:SELLERS, DORY (DDS)
Entity type:Individual
Prefix:DR
First Name:DORY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 POPLAR AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7503
Mailing Address - Country:US
Mailing Address - Phone:901-683-9800
Mailing Address - Fax:
Practice Address - Street 1:4515 POPLAR AVENUE
Practice Address - Street 2:SUITE 406
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-683-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist