Organization
GARY M SHELLERUD DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY M SHELLERUD DDS (OWNER)
(509) 838-4321
Entity
Organization
Contact information
Practice address
508 W 6TH AVE STE 208, SPOKANE, WA 99204-2730
(509) 838-4321
(509) 838-4618
Mailing address
508 W 6TH AVE STE 208, SPOKANE, WA 99204-2730
(509) 838-4321
(509) 838-4618
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
5678
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124163068
NPI
—
Enumeration date
08/26/2016
Last updated
08/26/2016
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