Andrew Peter Sholudko, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60484387 Issued in WA

Practice address

10830 19TH Ave SE
Suite a
Everett, WA 98208-5181

Phone

(774) 278-0412

NPI assigned

Jul 16, 2013

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

Other identifiers 1

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 and National Provider Directory roles.

• Andrew Sholudko PLLC

  • Dental Clinic/Center
  • Everett, WA
  • NPI 1063806693
  NPD (past) Authorized official

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1992146161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10830 19TH AVE SE",
            "address_2": "SUITE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982085181",
            "telephone_number": "774-278-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10830 19TH AVE SE",
            "address_2": "SUITE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982085181",
            "telephone_number": "774-278-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOLUDKO",
        "first_name": "ANDREW",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-16",
        "last_updated": "2023-03-07",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60484387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DENTAL LICENSE",
            "identifier": "DE6484387",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judy A Shirley, MSW
• Lora Shiveley
• Stewart Craig Shively, PA-C
• Abreham Shoangizaw
• James Andrew Shoemaker, PHARMD
• Krystall Shook, LMP
• Misty Renee Shook
• Srilatha Shoroff, MD
• Joanne Rachel Short
• Misty Donalee Short, M.A., CCC-SLP

• General Practice Dentistry in Everett, WA
• Providers in Everett, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.