Shelly Rea Sullens, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D6207 Issued in OR

Practice address

121 SW 5TH St
Canyonville, OR 97417-8718

Phone

(888) 468-0022

Fax

(541) 504-3907

NPI assigned

Feb 3, 2009

Sex

Female

Sole proprietor

No

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

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435017600000",
    "number": "1124266804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 SW UMATILLA AVE",
            "address_2": "SUITE 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977567039",
            "telephone_number": "541-504-3900",
            "fax_number": "541-504-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SW 5TH ST",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974178718",
            "telephone_number": "888-468-0022",
            "fax_number": "541-504-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLENS",
        "first_name": "SHELLY",
        "middle_name": "REA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-03",
        "last_updated": "2015-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tari Ellen Shapiro, RPH
• James Brian Siegel, DC
• Carolyn Elizabeth Simmons, M.D.
• David Allen Stevens, R.PH.
• Shannon Briana Suhr, FNP
• Sarah L Swanson
• Nicole C Taber, LMT
• Anandita Tiwari, M.D.
• Tina Joy Vernoy, LMT
• Micah Evan Walter, PHARM.D., R.PH.,CIP

• Dentist in Canyonville, OR
• Providers in Canyonville, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.