Gary M Shellerud DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

5678 Issued in WA

Legal business name

GARY M SHELLERUD DDS

Practice address

508 W 6TH Ave Ste 208
Spokane, WA 99204-2730

Phone

(509) 838-4321

Fax

(509) 838-4618

NPI assigned

Aug 26, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Gary M Shellerud, DDSNPI 1124163068

Title

Owner

Phone

(509) 838-4321

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Michael Shellerud, DDS, PERIODONTIST

  • Periodontics
  • Spokane, WA
  • NPI 1124163068
  NPD (past) Authorized official
• Nathan L Johnson, DMD, MS

  • Dentist
  • Spokane, WA
  • NPI 1427318427
  NPD (past)

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1104372556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 W 6TH AVE STE 208",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042730",
            "telephone_number": "509-838-4321",
            "fax_number": "509-838-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 W 6TH AVE STE 208",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042730",
            "telephone_number": "509-838-4321",
            "fax_number": "509-838-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY M SHELLERUD DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "SHELLERUD",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-838-4321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "5678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1124163068",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Michael Garten, PA
• Gary L Garvin, M.ED., LMHC
• Roger D Garvin, M.D.
• Susan Laurie Garvin, MA
• Victoria Patricia Garwood, LICENSED MIDWIFE
• Marcela Alejandra Garza Garza, MD
• Alexander Angel Garza
• Allison Garza
• Cassandra Garza
• Brooke Gasaway

• Periodontics in Spokane, WA
• Providers in Spokane, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.