Healthcare Provider Details

I. General information

NPI: 1497271910
Provider Name (Legal Business Name): SHINE BRIGHT DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 HARWOOD RD
BEDFORD TX
76021
US

IV. Provider business mailing address

3212 HARWOOD RD
BEDFORD TX
76021-3902
US

V. Phone/Fax

Practice location:
  • Phone: 817-778-8822
  • Fax:
Mailing address:
  • Phone: 817-778-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number27141
License Number StateTX

VIII. Authorized Official

Name: DR. DENNIS DINH
Title or Position: DENTIST
Credential:
Phone: 817-778-8822