MEDICARE: E SHINE DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1447803051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E SHINE DDS PC

Provider Business Mailing Address
First Line	:	6321 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2941
Country	:	US
Telephone Number	:	718-751-0101
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	EVELYN FRANCO
Credential	:
Telephone Number	:	516-906-8668

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “E SHINE DDS PC ” Practice Location

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