Shelly Self DMD PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DE10256 Issued in WA

Legal business name

SHELLY SELF DMD PLLC

Practice address

19365 7TH Ave NE
Suite D 108
Poulsbo, WA 98370-7441

Phone

(360) 779-7115

Fax

(360) 779-3990

NPI assigned

Apr 7, 2014

Organization subpart

No

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

Authorized official

Name

McKinley T Self, DMD

Title

Manager

Phone

(360) 464-0779

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Poulsbo Children's Dentistry Doing business as

Locations

Practitioners 1

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

• Charles R Brown, D.D.S

  • Pediatric Dentistry
  • Poulsbo, WA
  • NPI 1396890810
  NPD (past)

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396828800000",
    "number": "1780003723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19365 7TH AVE NE",
            "address_2": "SUITE D 108",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707441",
            "telephone_number": "360-779-7115",
            "fax_number": "360-779-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19365 7TH AVE NE",
            "address_2": "SUITE D 108",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707441",
            "telephone_number": "360-779-7115",
            "fax_number": "360-779-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLY SELF DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-04-07",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "MCKINLEY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-464-0779",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "DE10256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5003603",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008098",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poulsbo Children's Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shades of Grace Emdr, Equine, Ifs Therapy, PLLC
• Kyan Shaffner, MA
• Shalom Hospice of Puget Sound LLC
• Sheila Andrews Inc
• Sheila C Lally, DO, PS
• Fangchen Shen, M.D.
• Kirk D Sherris, DPM
• Susan J Shlifer, MD
• Abigale J Shreve, PHARMD
• Hayley Siegenthaler, DPT

• Dental Clinic/Center in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.