Provider Demographics
NPI:1093086225
Name:SHINE DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:SHINE DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:207-769-4017
Mailing Address - Street 1:9224 TEDDY LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6799
Mailing Address - Country:US
Mailing Address - Phone:720-776-9401
Mailing Address - Fax:303-648-5433
Practice Address - Street 1:9224 TEDDY LN STE 102
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6799
Practice Address - Country:US
Practice Address - Phone:720-776-9401
Practice Address - Fax:303-648-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO-905211124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO-905211OtherDORA