Provider Demographics
NPI:1598279747
Name:SHINN KIDS DENTAL LLC
Entity Type:Organization
Organization Name:SHINN KIDS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-649-0181
Mailing Address - Street 1:5122 OLYMPIC DR NW
Mailing Address - Street 2:#A-101
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1767
Mailing Address - Country:US
Mailing Address - Phone:253-649-0181
Mailing Address - Fax:253-313-5892
Practice Address - Street 1:5122 OLYMPIC DR NW STE A101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1768
Practice Address - Country:US
Practice Address - Phone:253-649-0181
Practice Address - Fax:253-313-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental