Shine Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22490 Issued in TX

Legal business name

SHINE DENTAL PLLC

Practice address

1723 N Avenue K
Freeport, TX 77541-3605

Phone

(979) 233-1581

NPI assigned

Aug 17, 2015

Organization subpart

No

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

Authorized official

Name

Ross Romero

Title

President

Phone

(979) 233-1581

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1457727109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1723 N AVENUE K",
            "city": "FREEPORT",
            "state": "TX",
            "postal_code": "775413605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 N AVENUE K",
            "city": "FREEPORT",
            "state": "TX",
            "postal_code": "775413605",
            "telephone_number": "979-233-1581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "ROMERO",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-233-1581"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Freeport, TX
• Providers in Freeport, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.