Individual
MS. MIA R SELLARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
CLOVER FORK CLINIC, 101 CHAD ST, EVARTS, KY 40828-0039
(606) 837-2108
(606) 837-9389
Mailing address
CLOVER FORK CLINIC, PO BOX 39, EVARTS, KY 40828-0039
(606) 837-2108
(606) 837-9389
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6865
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60001864
—
KY
Enumeration date
09/13/2006
Last updated
10/21/2015
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