Healthcare Provider Details

I. General information

NPI: 1932017530
Provider Name (Legal Business Name): SELLERS DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 W ROSEBERRY ROAD SUITE 106
DONNELLY ID
83615
US

IV. Provider business mailing address

PO BOX 1810
MCCALL ID
83638-1810
US

V. Phone/Fax

Practice location:
  • Phone: 208-515-1466
  • Fax:
Mailing address:
  • Phone: 208-634-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD SELLERS
Title or Position: CEO
Credential: DMD
Phone: 208-515-1466