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General NPI Number Information
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NPI Number | 1730233768
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Entity Type | Organization
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Legal Business Name | RUSSELL SEHEULT, D.D.S., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 1180 NEVADA ST STE #100
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City | REDLANDS
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State | CA
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Zip | 92374-2894
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Country | US
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Telephone | 909-335-0474
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Fax | 909-335-0477
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Provider Business Mailing Address
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Address Line | 1180 NEVADA ST STE #100
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City | REDLANDS
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State | CA
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Zip | 92374-2894
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Country | US
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Telephone | 909-335-0474
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Fax | 909-335-0477
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL SEHEULT
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Credential | D.D.S.
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Telephone | 909-335-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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