NPIMap

Individual provider Active NPI

Bret E Shupack, DDS

  • Dentist
  • Seattle, WA
National Provider Identifier
1871625137
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00007765 Issued in WA
Practice address
1331 Harbor Ave SW
Ste 100
Seattle, WA 98116
Phone
(206) 933-9300
Fax
(206) 933-9301
NPI assigned
Mar 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE00007765 WA Primary

Addresses

Primary practice location

1331 Harbor Ave SW
Ste 100
Seattle, WA 98116

Mailing address

1331 Harbor Ave SW
Ste 100
Seattle, WA 98116
Phone (206) 933-9300

Other identifiers 1

IdentifierTypeStateIssuer
2684014OtherFLUT ACCT #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE00007765WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hanbit CHI, DDS, PS Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871625137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 HARBOR AVE SW",
            "address_2": "STE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98116",
            "telephone_number": "206-933-9300",
            "fax_number": "206-933-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 HARBOR AVE SW",
            "address_2": "STE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98116",
            "telephone_number": "206-933-9300",
            "fax_number": "206-933-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPACK",
        "first_name": "BRET",
        "middle_name": "E",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00007765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT ACCT #",
            "identifier": "2684014",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • 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.