Shelly Self, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE10256 Issued in WA

Practice address

19365 7TH Ave NE
Suite D108
Poulsbo, WA 98370-7441

Phone

(360) 779-7115

Fax

(360) 779-3990

NPI assigned

Feb 8, 2007

Last updated

May 20, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Miss Shelly Sin Former name

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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1336280957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9902 NE MONSAAS RD",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101103",
            "telephone_number": "360-464-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19365 7TH AVE NE",
            "address_2": "SUITE D108",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707441",
            "telephone_number": "360-779-7115",
            "fax_number": "360-779-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "SHELLY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010256",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE10256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008098",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2035573",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "SIN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Seattle Pain Center Medical Corporation (Seattle Pain Center)
• David Scott Secrest, M.A.
• Jennifer L Seeley, PHARM.D
• Amy Louise Seidewand, LM, CPM
• Jon Arne Selbyg, O.D.
• Marcela Serocki
• Donald James Setter, DO
• SFH Diagnostics LLC
• Shades of Grace Emdr, Equine, Ifs Therapy, PLLC
• Kyan Shaffner, MA

• Pediatric Dentistry in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; 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.