MEDICARE: SHINE DENTAL PLLC

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	22490	TX

General Provider Information

NPI Number	:	1457727109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINE DENTAL PLLC

Provider Business Mailing Address
First Line	:	1723 N AVENUE K
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 N AVENUE K
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3605
Country	:	US
Telephone Number	:	979-233-1581
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSS ROMERO
Credential	:
Telephone Number	:	979-233-1581

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

Similar Medicare Providers

1114917846 — ATLAS DENTAL LP
Practice Location Address:

1723 N AVENUE K
FREEPORT, TX
77541-3605

Practice Phone: 979-233-1581
Practice Fax: 979-233-8355

1275647661 — DR. JEFFREY L COPELAND D.D.S.
Practice Location Address:

1723 N AVENUE K
FREEPORT, TX
77541-3605

Practice Phone: 979-233-1581
Practice Fax:

1366780223 — DR. ISAIAH L HARRIS JR. D.D.S.
Practice Location Address:

1723 N AVENUE K
FREEPORT, TX
77541-3605

Practice Phone: 979-233-1581
Practice Fax: 979-233-8355

1417388398 — AY DENTAL PA
Practice Location Address:

1723 N AVENUE K
FREEPORT, TX
77541-3605

Practice Phone: 979-233-1581
Practice Fax:

1356166672 — DOLPHIN PARTNERS GROUP INC
Practice Location Address:

3605 FREEPORT BLVD SUITE E
SACRAMENTO, CA
95818

Practice Phone: 917-288-7477
Practice Fax:

1710976691 — MR. MAX GARY HOLLER L.A.T.
Practice Location Address:

1206 W 11TH ST
FREEPORT, TX
77541-5346

Practice Phone: 979-230-0291
Practice Fax:

Directions to “SHINE DENTAL PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.