Provider Demographics
NPI:1669051108
Name:OELLRICH, SHANA RAE (RDH)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RAE
Last Name:OELLRICH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:RAE
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2235 NE CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8068
Mailing Address - Country:US
Mailing Address - Phone:507-459-7288
Mailing Address - Fax:206-745-3811
Practice Address - Street 1:2235 NE CASTLE DR
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8068
Practice Address - Country:US
Practice Address - Phone:507-459-7288
Practice Address - Fax:206-745-3811
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHL61089106124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist