Provider Demographics
NPI:1891422309
Name:SHINE PEARL DENTAL AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SHINE PEARL DENTAL AND ASSOCIATES PLLC
Other - Org Name:FULTON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH CHAU
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-225-2266
Mailing Address - Street 1:2500 S MILLBEND DR APT 4105
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1889
Mailing Address - Country:US
Mailing Address - Phone:267-368-0366
Mailing Address - Fax:
Practice Address - Street 1:2445 FULTON ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-7837
Practice Address - Country:US
Practice Address - Phone:713-225-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHINE PEARL DENTAL AND ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-04
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty