Provider Demographics
NPI:1235864208
Name:SHIN, ALEX (DMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25647 MARINE VIEW DR S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8937
Mailing Address - Country:US
Mailing Address - Phone:206-914-5990
Mailing Address - Fax:
Practice Address - Street 1:409 2ND ST NE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3033
Practice Address - Country:US
Practice Address - Phone:253-845-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61317186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist