Provider Demographics
NPI:1912143371
Name:GUINN, SHELLEY MARIE (RDH, BSDH)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:GUINN
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 NW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3667
Mailing Address - Country:US
Mailing Address - Phone:360-576-1433
Mailing Address - Fax:
Practice Address - Street 1:2517 NW 117TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-3667
Practice Address - Country:US
Practice Address - Phone:360-576-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00004429124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist