Healthcare Provider Details

I. General information

NPI: 1457086662
Provider Name (Legal Business Name): SHINE ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11989 HOLLY ST
THORNTON CO
80233-1802
US

IV. Provider business mailing address

11989 HOLLY ST
THORNTON CO
80233-1802
US

V. Phone/Fax

Practice location:
  • Phone: 303-452-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON SCHEER
Title or Position: OWNER
Credential: DDS, MSD
Phone: 316-706-9318