Provider Demographics
NPI:1811075179
Name:SHINE, LAWRENCE J (PC DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:SHINE
Suffix:
Gender:M
Credentials:PC DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 E 63RD ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110
Mailing Address - Country:US
Mailing Address - Phone:816-523-7788
Mailing Address - Fax:816-444-1175
Practice Address - Street 1:1734 E 63RD ST
Practice Address - Street 2:SUITE 520
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110
Practice Address - Country:US
Practice Address - Phone:816-523-7788
Practice Address - Fax:816-444-1175
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0129361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice