SHELLY SELF DMD PLLC (NPI# 1780003723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780003723 |
| Entity Type | Organization |
| Organization Name | SHELLY SELF DMD PLLC |
| Other Organization Name | POULSBO CHILDREN'S DENTISTRY |
| Practice Address |
19365 7th Ave Ne Suite D 108 Poulsbo WA 98370-7441 |
| Practice Telephone | 3607797115 |
| Practice Fax Number | 3607793990 |
| Mailing Telephone | 3607797115 |
| Mailing Fax Number | 3607793990 |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2014-04-07 |
| Authorized Official Name | MCKINLEY T SELF (MANAGER) |
| Authorized Official Telephone | 3604640779 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DE10256 | WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 5003603 | 05 | |
| WA | 1008098 | 05 |
| Other Name | Type Code |
|---|---|
| Poulsbo Children's Dentistry | Doing Business As Name - Organization |
| Street Address |
19365 7TH AVE NE SUITE D 108 |
| 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 |
| 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 |
| 1336280957 | Shelly Self | Dentist | 19365 7th Ave Ne, Suite D108, Poulsbo, WA 98370-7441 | 2007-02-08 |
| 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 | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184230294 | Ng Russell Dds PC | Clinic/Center | 20307 Viking Ave Nw Ste 201, Poulsbo, WA 98370-8321 | 2020-09-23 |
| 1013409788 | Scott A Olson Dds Pllc | Clinic/Center | 18520 State Highway 305 Ne, Poulsbo, WA 98370-7453 | 2018-05-30 |
| 1194223537 | Kitsap Dental | Clinic/Center | 20730 Bond Rd Ne Ste 100, Poulsbo, WA 98370-9000 | 2018-01-31 |
| 1326566241 | Kaylee Wonder Dmd Pllc | Clinic/Center | 19410 8th Ave Ne Ste 102, Poulsbo, WA 98370-7379 | 2017-08-30 |
| 1609221449 | Doctors Noble Cramer Pllc | Clinic/Center | 20307 Viking Ave Nw, 201, Poulsbo, WA 98370 | 2016-04-29 |
| 1124267745 | Michael D Brooks Dmd, Ms, Pllc | Clinic/Center | 19365 7th Ave Ne Ste 114, Poulsbo, WA 98370-7441 | 2009-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700671 | K.lee, Dds, Pllc. | Clinic/Center | 20709 Mountain Hwy E # 102, Spanaway, WA 98387-8580 | 2020-11-06 |
| 1346841376 | Ralf F. Schuler, Dr. Med. Dent., Msd,pllc | Clinic/Center | 205 W Fairhaven Ave Ste C, Burlington, WA 98233-1062 | 2020-11-05 |
| 1356942684 | Healthy Smiles Northwest | Clinic/Center | 11808 18th St Se, Lake Stevens, WA 98258-2046 | 2020-11-03 |
| 1306446240 | Christine A Woodward, Dds, Pllc | Clinic/Center | 45860 Main St, Concrete, WA 98237 | 2020-10-29 |
| 1215535695 | Ellingsen Henneberg Pllc | Clinic/Center | 2607 S Southeast Blvd Ste B210, Spokane, WA 99223-7614 | 2020-10-16 |
| 1174121792 | Evolve Dental LLC | Clinic/Center | 4410 194th St Sw Ste A, Lynnwood, WA 98036-5598 | 2020-10-15 |
| 1326646035 | Natasha Habib Dds Ps | Clinic/Center | 1025 153rd St Se Ste 103, Mill Creek, WA 98012-4051 | 2020-10-14 |
| 1386241636 | Mellissa Ilgen, Dds, Pllc | Clinic/Center | 26114 Illinois Ave Ne, Kingston, WA 98346-7674 | 2020-10-08 |
| 1417554932 | Young, Yeung, Lee, Hockin, P.s | Clinic/Center | 2207 2nd Ave, Seattle, WA 98121-2016 | 2020-10-07 |
| 1164039731 | Consolidated Dental Three | Clinic/Center | 19221 108th Ave Se Ste 2, Renton, WA 98055-7369 | 2020-09-28 |
| 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.