Healthcare Provider Details

I. General information

NPI: 1790128189
Provider Name (Legal Business Name): SHINEY GEORGE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHINEY SAMUEL

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 KEYSER AVE
NATCHITOCHES LA
71457-6337
US

IV. Provider business mailing address

940 KEYSER AVE
NATCHITOCHES LA
71457-6337
US

V. Phone/Fax

Practice location:
  • Phone: 318-742-9333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number28729
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7853
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: