Provider Demographics
NPI:1326165689
Name:THOMAS, SHINY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHINY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14005 N HIGHWAY 183
Mailing Address - Street 2:SUITE 800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5953
Mailing Address - Country:US
Mailing Address - Phone:713-256-0951
Mailing Address - Fax:
Practice Address - Street 1:14005 N HIGHWAY 183
Practice Address - Street 2:SUITE 800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5953
Practice Address - Country:US
Practice Address - Phone:713-256-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543361223G0001X
TX250531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER
CAW809BMedicare ID - Type UnspecifiedHUDSON