DR. SHELLY SELF (NPI# 1336280957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336280957 |
| Entity Type | Individual |
| Full Name | DR. SHELLY SELF |
| Other Name | MISS SHELLY SIN |
| Credential | DMD |
| Practice Address |
19365 7th Ave Ne Suite D108 Poulsbo WA 98370-7441 |
| Mailing Address |
9902 Ne Monsaas Rd Bainbridge Island WA 98110-1103 |
| Practice Telephone | 3607797115 |
| Practice Fax Number | 3607793990 |
| Mailing Telephone | 3604640990 |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2014-05-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
DE00010256 | WA | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DE10256 | WA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2035573 | 05 | |
| WA | 1008098 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265706428 | Shelly M Self | Counselor | 301 W Main St, Ste 324, Ardmore, OK 73401-6337 | 2012-03-05 |
| Street Address |
19365 7TH AVE NE SUITE D108 |
| City | POULSBO |
| State | WA |
| Zip Code | 98370-7441 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699873844 | Scott A. Broadbent, D.d.s, P.s. | Dentist | 19365 7th Ave Ne, Suite 110, Poulsbo, WA 98370-7441 | 2006-09-20 |
| 1942674379 | Sound Oxygen Service LLC | Durable Medical Equipment & Medical Supplies | 19365 7th Ave Ne, Ste 107, Poulsbo, WA 98370-7441 | 2015-11-23 |
| 1568850014 | Barrett & Kushner Pllc | Dentist | 19365 7th Ave Ne, Suite 114, Poulsbo, WA 98370-7441 | 2015-01-07 |
| 1780003723 | Shelly Self Dmd Pllc | Clinic/Center | 19365 7th Ave Ne, Suite D 108, Poulsbo, WA 98370-7441 | 2014-04-07 |
| 1073789178 | Richard Frank Weatherill IIi | Dentist | 19365 7th Ave Ne, Suite 106, Poulsbo, WA 98370-7441 | 2008-05-08 |
| 1982722914 | Patrick Edward Barrett | Dentist | 19365 7th Ave Ne, Suite 114, Poulsbo, WA 98370-7441 | 2007-03-27 |
| 1518002500 | Kim Kevin Pulver | Dentist | 19365 7th Ave Ne, Suite 106, Poulsbo, WA 98370-7441 | 2007-02-20 |
| 1396890810 | Charles R Brown | Dentist | 19365 7th Ave Ne, Bldg D Suite 108, Poulsbo, WA 98370-7441 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790324010 | Francie Corinn Edens | Massage Therapist | 225 Nw Lindvig Way Suite# 6, Poulsbo, WA 98370 | 2020-01-03 |
| 1972155679 | Marcela Serocki | Massage Therapist | 18657 Wa-305, Suite 4, Poulsbo, WA 98370 | 2019-07-12 |
| 1508425943 | Ryan Brinton | Physical Therapist | Kitsap Physical Therapy and Sports Clinics, 19319 7th Ave Ne Ste 108, Poulsbo, WA 98370 | 2019-06-10 |
| 1598220816 | Naomi Whitney Orong | Massage Therapist | 19068 Nw Jenson Way, Suite 4b, Poulsbo, WA 98370 | 2019-02-01 |
| 1043774953 | Maryanne Phillips Bellman | Physical Therapist | 442 Viewmont Ave, Poulsbo, WA 98370 | 2019-01-24 |
| 1285102293 | Andrea Sander | Registered Nurse | 19883 12th Ave Ne, Poulsbo, WA 98370 | 2018-11-07 |
| 1376038281 | Sharon Renay Christor | Nurse Practitioner | 19160 Front St. Ne, Poulsbo, WA 98370 | 2018-06-25 |
| 1700304334 | Samantha Przybylek Gavinski | Nurse Practitioner | 19500 10th Ave Ne Suite 100, Poulsbo, WA 98370 | 2017-09-04 |
| 1285164327 | Johanna Taylor | Behavior Technician | 21786 Windmill Loop Nw, Poulsbo, WA 98370 | 2017-06-12 |
| 1568990554 | Eva Geurtsen | Physical Therapy Assistant | 19160 Front St, Poulsbo, WA 98370 | 2017-06-02 |
| Find all providers in zip 98370 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396890810 | Charles R Brown | Dentist | 19365 7th Ave Ne, Bldg D Suite 108, Poulsbo, WA 98370-7441 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740807890 | Plateau Kids Dentistry, LLC | Dentist | 2912 228th Ave Se Ste A, Sammamish, WA 98075-9305 | 2020-07-05 |
| 1528603503 | Ellen Polsky Dds and Bobby Virk Dmd, Ps | Dentist | 34704 11th Pl S Ste 101, Federal Way, WA 98003-8730 | 2019-11-13 |
| 1942843552 | Laura Stewart Dds Pllc | Dentist | 6821 Ne 181st St, Kenmore, WA 98028-5034 | 2019-10-26 |
| 1639736119 | Southcenter Children's Dentistry | Dentist | 411 Strander Blvd Ste 303, Tukwila, WA 98188-2924 | 2019-05-21 |
| 1770147001 | Kaitlin Neste Pllc | Dentist | 360 Tormey Ln Ne Ste 198, Bainbridge Island, WA 98110-1990 | 2019-04-22 |
| 1124511126 | Roger Lucas, P.s. | Dentist | 3806 116th St. Ne, Marysville, WA 98271 | 2018-06-13 |
| 1497248017 | Jinju Song Dmd Pllc | Dentist | 9707 Ne 119th Way, Kirkland, WA 98034-8955 | 2018-06-08 |
| 1861999864 | Peter Douglas | Dentist | 32105 1st Ave S Ste B3, Federal Way, WA 98003-5719 | 2018-04-07 |
| 1669994042 | Annikka Louise Frostad-thomas | Dentist | 700 Nw Gilman Blvd # E412, Issaquah, WA 98027-5395 | 2017-07-07 |
| 1831624402 | Minh Dau, Dds and Raymond Park, Dds Pllc | Dentist | 3105 Alderwood Mall Blvd, Suite 117, Lynnwood, WA 98036-4703 | 2017-04-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.