# SHELLY SELF DMD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Poulsbo Children's Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780003723
- **Authorized official:** MCKINLEY T SELF DMD (MANAGER)
- **Authorized official phone:** (360) 464-0779

## Contact information

- **Practice address:** 19365 7TH AVE NE, SUITE D 108, POULSBO, WA 98370-7441
- **Practice address phone:** (360) 779-7115
- **Practice address fax:** (360) 779-3990
- **Mailing address:** 19365 7TH AVE NE, SUITE D 108, POULSBO, WA 98370-7441
- **Mailing address phone:** (360) 779-7115
- **Mailing address fax:** (360) 779-3990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DE10256 | WA | Yes |

## Other

- **Enumeration date:** 04/07/2014
- **Last updated:** 04/07/2014