Provider Demographics
NPI:1114693793
Name:PATRICK J. SHINE, DMD, P.A.
Entity Type:Organization
Organization Name:PATRICK J. SHINE, DMD, P.A.
Other - Org Name:SHINE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-221-8607
Mailing Address - Street 1:607 BENSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3988
Mailing Address - Country:US
Mailing Address - Phone:919-772-7030
Mailing Address - Fax:919-772-7810
Practice Address - Street 1:607 BENSON RD STE A
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3988
Practice Address - Country:US
Practice Address - Phone:919-772-7030
Practice Address - Fax:919-772-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty