Individual
DR. SHELLY SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DE00010256
WA
1223P0221X
Pediatric Dentistry
Primary
DE10256
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008098
—
WA
05
—
2035573
—
WA
Enumeration date
02/08/2007
Last updated
05/20/2014
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