Provider Demographics
NPI:1194591875
Name:SHINE PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:SHINE PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SEELIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:314-306-0003
Mailing Address - Street 1:116 CREIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-2204
Mailing Address - Country:US
Mailing Address - Phone:314-306-0003
Mailing Address - Fax:
Practice Address - Street 1:1921 NASHVILLE PIKE STE 200
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-5259
Practice Address - Country:US
Practice Address - Phone:314-306-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty