Healthcare Provider Details

I. General information

NPI: 1295591931
Provider Name (Legal Business Name): SHELBY CANSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST # B-307
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1204 18TH ST
ANACORTES WA
98221-2308
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-6996
  • Fax:
Mailing address:
  • Phone: 360-588-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDENT.DE.70093415
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: