MEDICARE: DR. KAREN LYNN SHINES D.M.D.

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	1223G0001X	General Practice Dentistry	6513	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6513	OTHER	KY	GENERAL DENTIST

General Provider Information

NPI Number	:	1255396214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN LYNN SHINES D.M.D.

Provider Business Mailing Address
First Line	:	BRAVE RIFLES REGIMENT RD
Second Line	:	2724
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5520
Country	:	US
Telephone Number	:	502-624-6158
Fax Number	:	502-624-2966

Provider Business Practice Location Address
First Line	:	BRAVE RIFLES REGIMENT RD
Second Line	:	2724
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5520
Country	:	US
Telephone Number	:	502-624-6158
Fax Number	:	502-624-2966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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