Gary Michael Shellerud, DDS, PERIODONTIST

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

00005678 Issued in WA

Practice address

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

Phone

(509) 838-4321

Fax

(509) 838-4618

NPI assigned

Feb 20, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gary M Shellerud DDS

  • Periodontics
  • Spokane, WA
  • NPI 1104372556
  NPD (past) Authorized official

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124163068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 E SILVER SPUR LN",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992179321",
            "telephone_number": "509-467-2407"
        },
        {
            "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": {
        "last_name": "SHELLERUD",
        "first_name": "GARY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS, PERIODONTIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "00005678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James S Shelby, D.D.S.
• Kristin Anna Shelby, RPH
• Kendall Shelford, RD
• Christopher M Sheller
• Tye Leigh Sheller
• Stephanie Ann Shelley, RPH, CGP, CACP
• Katherine Rose Shellorne, L.M.P.
• Abigail Grace Shelton, SLP
• Brooke Shelton, SLP
• Judd Preston Shelton, D.O.

• 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 Jul 8, 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.