DR. GARY MICHAEL SHELLERUD (NPI# 1124163068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124163068 |
| Entity Type | Individual |
| Full Name | DR. GARY MICHAEL SHELLERUD |
| Credential | DDS, PERIODONTIST |
| Practice Address |
508 W 6th Ave Ste 208 Spokane WA 99204-2730 |
| Mailing Address |
4309 E Silver Spur Ln Spokane WA 99217-9321 |
| Practice Telephone | 5098384321 |
| Practice Fax Number | 5098384618 |
| Mailing Telephone | 5094672407 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
00005678 | WA | Dental Providers |
| Street Address |
508 W 6TH AVE STE 208 |
| City | SPOKANE |
| State | WA |
| Zip Code | 99204-2730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104372556 | Gary M Shellerud Dds | Dentist | 508 W 6th Ave Ste 208, Spokane, WA 99204-2730 | 2016-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982250957 | Megan Elizabeth Dibenedetto | Pharmacist | 105 West 8th Avenue, 350e, Spokane, WA 99204 | 2019-08-14 |
| 1619521168 | Evelyn R Cabon | Genetic Counselor, MS | 101 W. 8th Avenue Suite 1100, Spokane, WA 99204 | 2019-08-01 |
| 1346700655 | Christina Rose | Student in an Organized Health Care Education/Training Program | 120 W. 8th Avenue, Spokane, WA 99204 | 2019-03-22 |
| 1508339862 | Cody J French | Physical Therapist | Washington Outpatient Rehab, 507 S Washington, Spokane, WA 99204 | 2019-01-09 |
| 1730655598 | Washington Outpatient Rehabilitation, LLC | Physical Therapist | 507 S. Washington St., Suite 10, Spokane, WA 99204 | 2018-10-19 |
| 1013405547 | Joel James Hayden | Student in an Organized Health Care Education/Training Program | Providence Sacred Heart, 101 West 8th Avenue, Spokane, WA 99204 | 2018-04-30 |
| 1144694787 | Brooksjohnsonpllc | Dentist | 1004 S. Monroe Street, Ste 100, Spokane, WA 99204 | 2015-11-19 |
| 1497184196 | Kathalene M Cassels | Physician Assistant | 810 W. 5th Ave. Ste 510, Spokane, WA 99204 | 2013-11-04 |
| 1174880454 | Kelly E Wurzel | Psychiatry & Neurology | 624 E. Front Ave, Spokane, WA 99204 | 2012-04-11 |
| 1003190331 | Katie L Gomez | Nurse Practitioner | 805 W. 5th Ave, Suite 518, Spokane, WA 99204 | 2011-10-05 |
| Find all providers in zip 99204 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265642375 | David W Engen Dds Ps | Dentist | 6817 N Cedar Rd Ste 202, Spokane, WA 99208-4277 | 2007-05-23 |
| 1659596948 | David Wayne Engen | Dentist | 9911 N Nevada St Ste 110, Spokane, WA 99218 | 2007-04-13 |
| 1538256854 | Steven D Aeschliman | Dentist | 15 E Central Ave, Spokane, WA 99208-1109 | 2006-10-06 |
| 1336235472 | Anthony G Giardino | Dentist | 2700 S Southeast Blvd Ste 210, Spokane, WA 99223-4984 | 2006-10-05 |
| 1831708833 | Andrea Pizzini | Dentist | 9911 N Nevada St, Spokane, WA 99218-1298 | 2020-07-24 |
| 1629524061 | South Hill Periodontics | Dentist | 2700 S Southeast Blvd, Suite 210, Spokane, WA 99223-4984 | 2016-08-26 |
| 1104372556 | Gary M Shellerud Dds | Dentist | 508 W 6th Ave Ste 208, Spokane, WA 99204-2730 | 2016-08-26 |
| 1609212687 | Douglas Gregg Rundle | Dentist | 10121 N Nevada St, Suite 102, Spokane, WA 99218-3120 | 2013-05-16 |
| 1538315296 | Douglas G. Rundle, D.m.d, P.c | Dentist | 10121 N Nevada St, Suite 102, Spokane, WA 99218-3120 | 2008-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225653397 | Rika Takada | Dentist | B403 Health Sciences Building, Seattle, WA 98195-0001 | 2020-06-14 |
| 1467074757 | Amit Srikant Gharpure | Dentist | 1959 Ne Pacific Street Health Science Center Room B-403, Seattle, WA 98195-0001 | 2020-05-10 |
| 1922632843 | Jessica Hsu | Dentist | 625 4th Ave Ste 201, Kirkland, WA 98033-9028 | 2020-02-29 |
| 1992338891 | Ehsan Zahedi | Dentist | 18009 Highway 99 Ste F, Lynnwood, WA 98037-4499 | 2020-02-19 |
| 1780142729 | Shoko Sato | Dentist | 2505 S 320th St Ste 330, Federal Way, WA 98003-5461 | 2019-03-08 |
| 1942738497 | Yu Lwo | Dentist | 1740 Nw Maple St Ste 110, Issaquah, WA 98027-8000 | 2017-05-30 |
| 1134677792 | Mill Creek Implants & Periodontics | Dentist | 15130 Main St Ste 210, Mill Creek, WA 98012-7370 | 2016-09-13 |
| 1164890026 | Shih-chung Liao | Dentist | 720 Olive Way Ste 810, Seattle, WA 98101-1836 | 2015-09-09 |
| 1225445539 | Implant & Periodontic Specialists | Dentist | 1418 112th Ave Ne Suite 100, Bellevue, WA 98004 | 2014-07-18 |
| 1093147068 | Etheridge Family Dentistry | Dentist | 3130 E Madison St Ste 103, Seattle, WA 98112-4221 | 2013-08-01 |
| 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.