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Organization
SC SHINE PLLC
Active
Organization
SC SHINE PLLC
Active
Other names
Texas Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JUSTIN COKE BA (OWNER)
(210) 495-2000
Entity
Organization
Contact information
Practice address
10103 W LOOP 1604 N, STE 104, SAN ANTONIO, TX 78254-9715
(210) 495-2000
(210) 495-2001
Mailing address
2211 NW MILITARY HWY, SUITE 212, SAN ANTONIO, TX 78213-1859
(210) 495-2000
(210) 495-2001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21002
TX
Other
Enumeration date
01/14/2008
Last updated
03/31/2015
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