Provider Demographics
NPI:1912219007
Name:SHINER DENTAL, PLLC
Entity Type:Organization
Organization Name:SHINER DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-594-2800
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:821 N AVE D
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-0556
Mailing Address - Country:US
Mailing Address - Phone:361-594-2800
Mailing Address - Fax:361-594-4109
Practice Address - Street 1:821 N AVE D
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-0556
Practice Address - Country:US
Practice Address - Phone:361-594-2800
Practice Address - Fax:361-594-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22987261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental