Basic Information
| Provider Information | |||||||||
| NPI: | 1255396214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHINES | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | BRAVE RIFLES REGIMENT RD | ||||||||
| Address2: | 2724 | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026246158 | ||||||||
| FaxNumber: | 5026242966 | ||||||||
| Practice Location | |||||||||
| Address1: | BRAVE RIFLES REGIMENT RD | ||||||||
| Address2: | 2724 | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026246158 | ||||||||
| FaxNumber: | 5026242966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6513 | KY | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 6513 | 01 | KY | GENERAL DENTIST | OTHER |