Shine Pediatric Dental Co.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SHINE PEDIATRIC DENTAL CO.

Practice address

2631 Gattis School Rd
Round Rock, TX 78664-2821

Phone

(512) 698-8766

NPI assigned

Nov 4, 2022

Organization subpart

No

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

Authorized official

Name

Sarah Severson, DDSNPI 1164977047

Title

Owner

Phone

(512) 698-8766

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Sarah Marie Severson, D.D.S.

  • Dentist
  • San Marcos, TX
  • NPI 1164977047
  NPD Authorized official

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

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1548977895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 TWELVE OAKS LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787046355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 GATTIS SCHOOL RD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642821",
            "telephone_number": "512-698-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE PEDIATRIC DENTAL CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-04",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "SEVERSON",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-698-8766",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jing Shi, MA, LPC
• Abigail Regan Shier
• Angela Roxanne Shilling, CST/SFA
• Shilpa B. Patel, PA
• Patrick Wonil Shin, MD
• Monica L Shipman, PA-C
• Aarti V Shirodkar
• Ahmed Nezar Shobassy, M.D.
• Ryan Shock, DPM
• Cayenne Shpall, PH.D, BCBA-D

• Pediatric Dentistry in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.