Provider Demographics
NPI:1912448978
Name:SHINE, PATRICK J (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:SHINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 BENSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3988
Mailing Address - Country:US
Mailing Address - Phone:919-772-7030
Mailing Address - Fax:919-772-7810
Practice Address - Street 1:607 BENSON RD STE A
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3988
Practice Address - Country:US
Practice Address - Phone:919-772-7030
Practice Address - Fax:919-772-7810
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC11734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program