Shine Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SHINE DENTAL LLC

Practice address

1020 4TH St SE Ste 200
Saint Cloud, MN 56304-1245

Phone

(320) 980-6031

NPI assigned

Aug 17, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mahado Onwukwe

Title

Authorized Official

Phone

(320) 980-6031

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1786924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1114832839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 4TH ST SE STE 200",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563041245",
            "telephone_number": "320-980-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 4TH ST SE STE 200",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563041245",
            "telephone_number": "320-980-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-17",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "ONWUKWE",
        "authorized_official_first_name": "MAHADO",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "320-980-6031",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Saint Cloud, MN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.