NPIMap

Organization Active NPI

SC Shine PLLC

Doing business as Texas Dental

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1356527949
Registry record updated Mar 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21002 Issued in TX
Legal business name
SC SHINE PLLC
Doing business as
Texas Dental
Practice address
10103 W Loop 1604 N
Ste 104
San Antonio, TX 78254-9715
Phone
(210) 495-2000
Fax
(210) 495-2001
NPI assigned
Jan 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2015

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

Authorized official

Name
Mr. Michael Justin Coke, BA
Title
Owner
Phone
(210) 495-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 21002 TX Primary

Addresses

Primary practice location

10103 W Loop 1604 N
Ste 104
San Antonio, TX 78254-9715

Mailing address

2211 NW Military Hwy
Suite 212
San Antonio, TX 78213-1859
Phone (210) 495-2000

Other names 1

  • Texas Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2211 NW Military Hwy
#212
San Antonio, TX 78213

10103 W Loop 1604 N
#7
San Antonio, TX 78254

2211 NW Military Hwy
Ste 212
San Antonio, TX 78213

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1356527949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 NW MILITARY HWY",
            "address_2": "SUITE 212",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131859",
            "telephone_number": "210-495-2000",
            "fax_number": "210-495-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10103 W LOOP 1604 N",
            "address_2": "STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782549715",
            "telephone_number": "210-495-2000",
            "fax_number": "210-495-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SC SHINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "COKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-495-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; 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.