Healthcare Provider Details

I. General information

NPI: 1689148025
Provider Name (Legal Business Name): SHINE ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 HOLLY ST STE B
THORNTON CO
80233-1802
US

IV. Provider business mailing address

3127 W 18TH AVE
DENVER CO
80204-1705
US

V. Phone/Fax

Practice location:
  • Phone: 316-706-9318
  • Fax:
Mailing address:
  • Phone: 316-706-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

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