Provider Demographics
NPI:1649979212
Name:NINNEMAN, SHALE MELISSA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHALE
Middle Name:MELISSA
Last Name:NINNEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 A 212TH AVE SE, A
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075
Mailing Address - Country:US
Mailing Address - Phone:425-647-3747
Mailing Address - Fax:
Practice Address - Street 1:2704 A 212TH AVE SE, A
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075
Practice Address - Country:US
Practice Address - Phone:425-647-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program