Fenris Scudder, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

DE00007430 Issued in WA

Practice address

3100 SE Old Olympic Hwy
Shelton, WA 98584-7731

Phone

(360) 427-1784

Fax

(360) 427-1818

NPI assigned

Jul 30, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kamilche Dental Center

  • Dentist
  • Shelton, WA
  • NPI 1043379480
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185753600000",
    "number": "1053501668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SE OLD OLYMPIC HWY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847731",
            "telephone_number": "360-427-1784",
            "fax_number": "360-427-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SE OLD OLYMPIC HWY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847731",
            "telephone_number": "360-427-1784",
            "fax_number": "360-427-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCUDDER",
        "first_name": "FENRIS",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00007430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS PROVIDER NUMBER",
            "identifier": "5027990",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shera B Schnitzer
• John Shay Schreiber, D.D.S.
• William Edward Schrock, RPH
• Erica Elizabeth Schuman, ARNP
• Lorraine Jean Scott, AAC
• Leora Ellen Sears, LMP
• Claudette V. Selkridge, MC60489858
• Christine Semanko, CDP
• Sendero Counseling Services
• Sendero Counseling Services

• Dentist in Shelton, WA
• Providers in Shelton, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.