Self, Shelly

Self, Shelly is an sole proprietor health care provider with primary practice located at 19365 7Th Ave Ne Suite D108, Poulsbo WA 98370-7441. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is her primary health care specialty. Self, Shelly can be contacted via phone (360) 779-7115.

Contact Information

Primary practice address
19365 7Th Ave Ne Suite D108 Poulsbo WA 98370-7441
Phone: (360) 779-7115
Fax: (360) 779-3990
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DE00010256 Washington
Dental Providers / Pediatric Dentistry 1223P0221X DE10256 Washington

Profile Details

NPI number 1336280957
LBN Legal business name Self, Shelly
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 8th, 2007
Last updated May 20th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336280957 NPPES
Washington MEDICAID 2035573
Washington MEDICAID 1008098

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