=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114302783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL SELLERS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2015
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 VETERANS DR
-----------------------------------------------------
City | FLORESVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78114-2859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-393-7190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 W OAKLAWN RD
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78064-4033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-569-8940
-----------------------------------------------------
Fax | 830-224-6905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 31058
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 31058
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------